Chapter 29 - Peripheral Nerve Stimulation for Pain Peripheral Neuralgia and Complex Regional Pain Syndrome

Abstract

This chapter focuses on the use of peripheral nerve stimulation (PNS) for treating pain peripheral neuralgia and complex regional pain syndrome. Peripheral nerve stimulation is indicated for painful neuralgias affecting any peripheral or cranial nerve and can be a highly effective clinical modality for the management of neuropathic pain. Percutaneous electrodes have been used to test the viability of PNS and a trial of PNS after implantation of electrodes on the target nerve can be undertaken by attaching the lead cable to an externalized pulse generator. A prelude to PNS is a psychological evaluation and counseling to ensure that patients understand the limitations and complexities of this therapy. An increasing number of implanting surgeons are using PNS for upper and lower extremity neuropathic pain, and the neural targets include cranial nerves, occipital, sacral, genitofemoral, ilioinguinal, and ileo-hypogastric nerves. The most commonly used electrodes are either a paddle type electrode, a percutaneous electrode of the type used for SCS, or a small bipolar or multi-contact electrode similar to the one used for functional electrical stimulation. In the USA, PNS is approved by the Food and Drug Administration (FDA) in conjunction with a Resume or On-Point electrode. The current incidence of technical failure is directly related to equipment currently available and in most cases, it is a result of distraction from the target nerve due to scarring. A more appropriately designed electrode that accommodates to the shape and size of peripheral nerves would not only obviate this problem, but would also reduce the procedural time required by the surgeons.