Peripheral Nerve Stimulation For Treatment Research Articles

ID:16066 IPG-Free Peripheral Nerve Stimulation for Treatment of Lower Extremity Peripheral Neuropathy in a Diabetic Amputee

A 29-year-old female with type-1 diabetes mellitus complicated by a non-healing right foot wound presented to our clinic with left lower extremity neuropathic pain following a right below knee amputation (BKA). She complained mostly of pain on the lateral and medial aspects of her left lower calf. Treatment with traditional medications (gabapentin, Lyrica) did not provide sufficient pain relief. A diagnostic injection at the distal peroneal and saphenous nerves at the ankle relieved the majority of her pain for ∼36hr. Subsequently, patient was considered a candidate for wireless peripheral nerve stimulation. Patient underwent a PNS trial (Stimwave, Pompano Beach, Florida) in clinic in which temporary leads were placed along the distal aspects of the above-mentioned nerves using fluoroscopic guidance. Intra-op testing confirmed adequate coverage of the painful areas. Patient’s trial lasted 4 days at which point she was scheduled for permanent implantation.

Peripheral Nerve Stimulation for Treatment of Headaches: An Evidence-Based Review.

Headaches are one of the most common medical complaints worldwide, and treatment is often made difficult because of misclassification. Peripheral nerve stimulation has emerged as a novel treatment for the treatment of intractable headaches in recent years. While high-quality evidence does exist regarding its use, efficacy is generally limited to specific nerves and headache types. While much research remains to bring this technology to the mainstream, clinicians are increasingly able to provide safe yet efficacious pain control.

Subcutaneous Peripheral Nerve Stimulation for Treatment of Acute/Subacute Herpes Zoster-related Trigeminal Neuralgia: A Retrospective Research.

The purpose of this study was to observe the effect of subcutaneous stimulation of the peripheral nerve on acute or subacute zoster occurring in trigeminal nerve branches, and to evaluate the preventive effect of prior temporary implant of a peripheral stimulation electrode in the acute or subacute phase of herpes zoster (HZ) (from 30 to 90 d after zoster onset) before postherpetic neuralgia (PHN) presents. A total of 26 patients' medical records were analyzed. All of patients had received temporary subcutaneous peripheral nerve stimulation (PNS). The clinical efficacy of treatment was evaluated on a visual analog scale (VAS), and dosages of pain medication were recorded before and at 1 to 6 months after the temporary stimulation. The rate of PHN was reevaluated at a 6 months follow-up. There was a significant decrease in VAS values after PNS. Medication doses decreased significantly after TPNS. The rate of clinically meaningful PHN (VAS >3) dropped below 4%. This study revealed that PNS is an effective treatment for trigeminal herpetic neuralgia following acute or subacute HZ. As a extend neuromodulation method, subcutaneous peripheral nerve-field stimulation might be a useful option to reduce the progression of neuropathic changes caused by persistent transmission of pain signals in the trigeminal nerve branches after the acute or subacute phase of HZ.

Peripheral Nerve Stimulation for Treatment of Severe Refractory Upper Extremity Post-Amputation Pain

Severe pain is a significant and potentially debilitating consequence of amputation and may be highly challenging to treat ( 1. Hsu E Cohen SP Postamputation pain: epidemiology, mechanisms, and treatment. J Pain Res. 2013; 6: 121-136 PubMed Google Scholar ). Amputees frequently have a combination of phantom limb pain (PLP) and residual limb pain (RLP). Peripheral nerve stimulation (PNS) is an advantageous form of neuromodulation that provides more selective stimulation and analgesia, as well as less procedural invasiveness, compared to traditional spinal cord stimulation (SCS). With the introduction of novel, commercially available, percutaneous systems, PNS is re-emerging as a useful therapy for neuropathic pain ( 2. Rauck RL Cohen SP Gilmore CA et al. Treatment of post-amputation pain with peripheral nerve stimulation. Neuromodulation. 2014; 17: 188-197 Abstract Full Text Full Text PDF PubMed Google Scholar , 3. Cohen SP Gilmore CA Rauck RL et al. Percutaneous peripheral nerve stimulation for the treatment of chronic pain following amputation. Mil Med. 2019; 184: e267-e274 Crossref PubMed Scopus (15) Google Scholar ). This modality utilizes electrodes adjacent to peripheral nerves to treat painful conditions such as peripheral neuropathic pain and complex regional pain syndrome (CRPS) ( 4. Petersen BA Nanivadekar AC Chandrasekaran S Fisher LE Phantom limb pain: peripheral neuromodulatory and neuroprosthetic approaches to treatment. Muscle Nerve. 2019; 59: 154-167 Crossref PubMed Scopus (6) Google Scholar ). Recent research including a multicenter, randomized, controlled trial (RCT) has shown the effectiveness of PNS for lower extremity post-amputation pain ( 2. Rauck RL Cohen SP Gilmore CA et al. Treatment of post-amputation pain with peripheral nerve stimulation. Neuromodulation. 2014; 17: 188-197 Abstract Full Text Full Text PDF PubMed Google Scholar , 3. Cohen SP Gilmore CA Rauck RL et al. Percutaneous peripheral nerve stimulation for the treatment of chronic pain following amputation. Mil Med. 2019; 184: e267-e274 Crossref PubMed Scopus (15) Google Scholar , 5. Gilmore CA, Ilfeld BM, Rosenow JM et al. Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2019;rapm-2019-100937. https://pubmed.ncbi.nlm.nih.gov/31740443/. Google Scholar ). These studies have shown improvement in both PLP and RLP, which makes this modality attractive for use with amputees. Notably, all studies to date have been limited exclusively to the lower extremity. Thus, we present a case description of PNS used for treatment of severe refractory upper extremity post-amputation pain.

Peripheral Nerve Stimulation for Treatment of Painful Osteoarthritis of the Knee: A Case Report

BACKGROUND: Osteoarthritic knee (OAk) pain is common, yet the standard of care often yields unsatisfactory pain relief. There remains a role for novel treatment options. Percutaneous motor peripheral nerve stimulation (mPNS) of the knee is a novel minimally invasive procedure that stimulates motor end points leading to muscle contraction associated with the painful joint. Pain relief is hypothesized to be achieved through central pain modulation. CASE REPORT: We report the case of a patient who experienced refractory osteoarthritic knee pain after 9 months of conservative care. Following 7 weeks of mPNS treatment, the patient achieved improvement in OAk pain relief and activities of daily living as measured by notable improvements in the Brief Pain Inventory-Short Form and Knee Injury and Osteoarthritis Outcome Score at 8- and 12-weeks postimplant. The Patient Global Impression of Change at the end of stimulation was much improved. CONCLUSION: Motor PNS may offer a safe and effective treatment alternative for chronic refractory pain related to OAk. KEY WORDS: Osteoarthritis, knee, pain, peripheral nerve stimulation

Percutaneous Peripheral Nerve Stimulation for Treatment of Brachial Plexopathy Secondary to Pancoast Tumor: A Case Report

Background: Pancoast tumors can result in significant arm and shoulder pain due to invasion of the lower brachial plexus (BP). They are usually treated by chemoradiotherapy followed by surgical resection, which may alleviate the pain. When patients respond poorly to chemoradiation and the tumor is not surgically resectable, options to treat the pain are limited. We report here successful use of percutaneous peripheral nerve stimulation (PNS) with leads inserted under ultrasound (US)-guidance for treatment of brachial plexopathy in a patient with an unresectable Pancoast tumor unresponsive to chemoradiation. Case Report: The patient was a 70-year-old woman with an unresectable poorly differentiated squamous cell carcinoma of the left lung status post chemoradiation with poor response and recently started on immune therapy who presented to her oncologist with refractory left upper extremity (LUE) pain and weakness. She was admitted for pain control, and pain management was consulted. Physical examination findings were concerning for involvement of the lower trunk of the BP, findings confirmed in imaging. Patient elected to proceed with placement of a PNS. Device was successfully placed under US guidance. Patient responded well for the first 2 weeks with significant improvement in allodynia and hyperesthesia, however, at week 3, physical examination was significantly changed and further growth of the tumor was seen on imaging. The PNS was removed at this time. Conclusion: This case demonstrates successful use of PNS to treat refractory neuropathic pain in a patient with a locally advanced Pancoast tumor. US imaging made it possible to identify the interscalene BP and accurately place the leads. The PNS achieved its desired outcome of providing pain relief in the lower trunk distribution for the full 3 weeks it was in place. Pain from Pancoast tumors can be severe, and neural blockade via PNS to interrupt pain is an option for patients with intractable pain. Additional prospective study is warranted to determine the efficacy of this technique. Key words: Brachial plexus, upper extremity, cancer pain, interventional pain management, neuromodulation, peripheral nerve stimulation

Peripheral Nerve Stimulation for Pain in Extremities: An Update.

Pain in extremities may occur in a variety of central and peripheral neuropathic and nociceptive syndromes, some of which may respond to central neuromodulation procedures. Peripheral neuromodulation techniques, either as a stand-alone therapy or as an adjuvant to spinal cord stimulation, may be particularly effective when the pain is localized to a part of a single extremity or when the source of the pain is related to the malfunction of a known peripheral nerve. Further, peripheral neuromodulation is used to treat disorders in which central simulation fails to provide discrete therapeutic paresthesia. Despite the fact that there are only a few neuromodulatory devices designed specifically for the periphery, clinical experiences are growing, and here we provide a clinical update on use of peripheral nerve stimulation (PNS) in management of chronic pain in extremities. Historical PNS strategies and innovative methods are reviewed and highlighted in this chapter. With the upcoming technological advances and new stimulation paradigms, along with clear updated guidelines statements, the utilization of PNS will likely continue to increase and improve the management of chronic pain syndromes in the extremities. The potential success of the novel devices specifically designed to target the peripheral nervous system is expected to positively impact and promote the use of PNS in treatment of chronic pain.

Peripheral Nerve Stimulation for Neuropathic Pain

Over the last two decades, electrical neuromodulation has become a dominant approach in surgical treatment of medically refractory neuropathic pain, essentially eclipsing multiple available neuroablative procedures. Among different types of neuromodulation, peripheral nerve stimulation (PNS) holds the unique position of being the least invasive - and at the same time the least established in terms of scientific evidence and regulatory approvals. However, it is now gaining tremendous momentum in terms of accumulation of clinical experience and development of new indications. As a matter of fact, recent European approval of PNS for treatment of chronic lower back pain and intractable migraine headaches is expected to add legitimacy and marketing support to the entire field of PNS. This article provides an overview of PNS history, reviews current thoughts regarding its mechanism of action, summarises common indications, clinical outcomes, technical procedural details and complications, and suggests future directions for PNS development. It appears that PNS today is the most rapidly growing field of neuromodulation - and that does not come as a surprise, considering its potential for treatment of very prevalent and hard-to-treat conditions, such as back pain and headaches. From the point of view of a practising neurologist, PNS presents an attractive pain management option that combines a high level of efficacy and reproducibility of results with low invasiveness and minimal morbidity. As the worldwide experience with PNS continues to grow, one may expect to see it becoming a widely accepted treatment approach in a variety of clinical conditions.

Peripheral nerve stimulation for treatment of postherpetic neuralgia: A Case report

Neuromodulation techniques have been successfully used for a varietyof neuropathic pain conditions. Th e aim of this paper is to presenta case of the successful use of a subcutaneously placed peripheralnerve stimulator for treatment of intractable postherpetic neuralgia(PHN). A 57-year old man presented with a two-year history of leftthoracic pain that developed aft er a vesicular rash. Focal neuropathicpain had not responded to treatment with multiple analgesic medicationsand steroid injections. Th e patient had signifi cant relief followingimplantation of a peripheral nerve stimulator. Th is case represents acontribution to the small but growing body of evidence indicating thatperipheral nerve stimulation may be an eff ective option for treatmentof PHN not responsive to less invasive modalities.

Peripheral Nerve Stimulation for Neuropathic Pain

Over the last two decades, electrical neuromodulation has become a dominant approach in surgical treatment of medically refractory neuropathic pain, essentially eclipsing multiple available neuroablative procedures. Among different types of neuromodulation, peripheral nerve stimulation (PNS) holds the unique position of being the least invasive—and at the same time the least established in terms of scientific evidence and regulatory approvals. However, it is now gaining tremendous momentum in terms of accumulation of clinical experience and development of new indications. As a matter of fact, recent European approval of PNS for treatment of chronic low back pain and intractable migraine headaches is expected to add legitimacy and marketing support to the entire field of PNS. This article provides an overview of PNS history, reviews current thoughts regarding its mechanism of action, summarizes common indications, clinical outcomes, technical procedural details, and complications, and suggests future directions for PNS development. It appears that PNS today is the most rapidly growing field of neuromodulation—and that does not come as a surprise, considering its potential for treatment of very prevalent and hard-to-treat conditions, such as back pain and headaches. From the point of view of a practicing neurologist, PNS presents an attractive pain management option that combines a high level of efficacy and reproducibility of results with low invasiveness and minimal morbidity. As the worldwide experience with PNS continues to grow, one may expect to see it becoming a widely accepted treatment approach in a variety of clinical conditions.

861 PERIPHERAL NERVE STIMULATION FOR TREATMENT OF TRIGEMINAL NEURALGIA

European Journal of PainVolume 13, Issue S1 p. S245c-S246 861 PERIPHERAL NERVE STIMULATION FOR TREATMENT OF TRIGEMINAL NEURALGIA A. Yakovlev, A. Yakovlev Comprehensive Pain Management of The Fox Valley, Appleton, United StatesSearch for more papers by this authorS. Karasev, S. Karasev Samara Medical Institute, Samara, RussiaSearch for more papers by this authorV. Yakovleva, V. Yakovleva Comprehensive Pain Management of the Fox Valley, SC Appleton, United StatesSearch for more papers by this author A. Yakovlev, A. Yakovlev Comprehensive Pain Management of The Fox Valley, Appleton, United StatesSearch for more papers by this authorS. Karasev, S. Karasev Samara Medical Institute, Samara, RussiaSearch for more papers by this authorV. Yakovleva, V. Yakovleva Comprehensive Pain Management of the Fox Valley, SC Appleton, United StatesSearch for more papers by this author First published: 12 January 2012 https://doi.org/10.1016/S1090-3801(09)60864-8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume13, IssueS1September 2009Pages S245c-S246 RelatedInformation

Trigeminal and occipital peripheral nerve stimulation for craniofacial pain: a single-institution experience and review of the literature

Treatment of chronic neuropathic pain in the region of the head and face presents a challenge for pain specialists; patients who do not respond to conventional treatment modalities usually continue to suffer from pain due to the lack of reliable medical and surgical approaches. Peripheral nerve stimulation (PNS) has been used to treat neuropathic pain for many decades, but only recently has it been applied systematically to the craniofacial region. To advance the study of this treatment option, the authors present their initial experience with this approach, summarize published data on the use of PNS in treatment of craniofacial pain, and discuss some technical details of the craniofacial PNS procedure. A review of prospectively collected data in 30 patients who underwent PNS surgery for craniofacial pain was performed. The pain location, duration, cause, and previous treatments were analyzed, along with the surgical details, initial and long-term results, complications, and repeated operations. Stimulated nerves in this group included supraorbital (seven patients), infraorbital (six), and occipital (21); in 19 patients more than one nerve was stimulated. Twenty-two patients proceeded with implantation of a permanent system after the trial. Of these, at the time of the latest evaluation (mean follow-up duration 35 months), in two patients the devices had been removed because of pain improvement over time, in three the devices were removed due to loss of effectiveness (two cases) or late infection (one), and the rest are enjoying either complete (15 patients) or partial (two patients) pain relief. Three patients underwent repeated operation due to lead erosion, infection, or migration. Peripheral nerve stimulation appears to be a safe and effective approach in the treatment of craniofacial neuropathic pain. The growing body of literature supports a wider acceptance of this approach in the field of pain surgery.