scholarly journals Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation

2014 ◽  
Vol 37 (3) ◽  
pp. 473-480 ◽  
Author(s):  
Giorgio Stevanato ◽  
Grazia Devigili ◽  
Roberto Eleopra ◽  
Pietro Fontana ◽  
Christian Lettieri ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
New Technique ◽  
Post Traumatic ◽  
A New Technique

Peripheral Nerve Stimulation of Brachial Plexus Nerve Roots and Supra-Scapular Nerve for Chronic Refractory Neuropathic Pain of the Upper Limb

2017 ◽  
Vol 20 (7) ◽  
pp. 684-689 ◽  
Author(s):  
Bénédicte Bouche ◽  
Marie Manfiotto ◽  
Philippe Rigoard ◽  
Jean Lemarie ◽  
Véronique Dix-Neuf ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Nerve Roots ◽  
Stimulation Of

scholarly journals Peripheral Nerve Stimulation of the Brachial Plexus for Chronic Refractory CRPS Pain of the Upper Limb: Description of a New Technique and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_1) ◽  
pp. S18-S26
Author(s):  
Thiago Nouer Frederico ◽  
Tiago da Silva Freitas
Keyword(s):  
Neuropathic Pain ◽  
Conservative Treatment ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Case Series ◽  
Pain Syndrome ◽  
Pain Scale ◽  
New Technique ◽  
A New Technique

Abstract Objective Upper limb complex regional pain syndrome is an important cause of chronic pain, and its treatment is challenging. In this pilot case series, we preliminarily evaluated the feasibility, effectiveness, and safety of a new technique for brachial plexus neuromodulation in the treatment of this disease in patients refractory to conservative treatment. Methods Between 2017 and 2018, 14 patients considered to be refractory to optimized conservative treatment were recruited to this study. In the first stage, patients were trialed for seven days with a new technique of implant of the brachial plexus. Patients with ≥50% pain relief in visual analog scale (VAS) score received a definitive implantation in the second stage. Follow-ups were conducted at pre-implant and 12 months using the Neuropathic Pain Scale, SF-32, and the visual analogic scale for pain. Results After the initial trial, 10 patients had a pain reduction of ≥50% and received a permanent implant. At 12-month follow-up, VAS, Neuropathic Pain Scale, SF-12 physical and mental scores improved by 57.4% +/- 10% (P = 0.005), 60.2% +/- 12.9% (P = 0.006), and 21.9% +/- 5.9% (P = 0.015), respectively. Conclusions Our data suggest that this new technique of brachial plexus stimulation may have long-term utility in the treatment of painful upper limb complex regional pain syndrome. New more detailed comprehensive studies should be carried out to confirm our findings in a larger population and to further refine the clinical implementation of this technique.

Ultrasound-guided peripheral nerve stimulation for neuropathic pain after brachial plexus injury: two case reports

2017 ◽  
Vol 31 (3) ◽  
pp. 453-457 ◽  
Author(s):  
Jung Hyun Kim ◽  
Sang Ho Shin ◽  
Young Rong Lee ◽  
Hyo Seon Lee ◽  
Jin Young Chon ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Nerve Stimulation ◽  
Brachial Plexus Injury ◽  
Case Reports ◽  
Peripheral Nerve Stimulation ◽  
Ultrasound Guided

Transcutaneous Peripheral Nerve Stimulation for the Treatment of Neuropathic Pain in the Upper Limb

2016 ◽  
Vol 21 (01) ◽  
pp. 37-43 ◽  
Author(s):  
A. Sierakowski ◽  
S.S. Jing ◽  
J. Poel ◽  
D. Elliot
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Peripheral Nerve ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Pain Severity ◽  
Intractable Pain ◽  
Paired Data ◽  
Number Of Patients

Background: A small number of patients develop intractable peripheral nerve pain following injury or surgery to the upper limb that is refractory to pharmacological treatment. This study reports our results of using transcutaneous peripheral nerve stimulation (TPNS), a non-invasive form of neuromodulation, to treat this difficult problem. Methods: Seventy-two patients were treated for intractable pain in the upper limb using this technique. Electrical current was delivered transcutaneously through a handheld probe, placed on the skin overlying the affected peripheral nerve proximal to the site of pain. Pain severity was determined before and immediately after treatment by subjective patient self-assessment using a visual analogue pain scale. Pre-post treatment changes in pain severity were analysed by Student's test for paired data. Outcome in respect of overall effectiveness of this treatment, was graded according to the maximum duration of pain relief achieved. Results: Overall, TPNS reduced pain intensity from 8.4 (SD 1.6) before treatment to 4.2 (SD 3.5) immediately after treatment, a highly significant effect ([Formula: see text]). The treatment achieved cure in 8/72 (11%) of our patients and a useful therapeutic outcome (pain relief ≥ 1 day) in 27/72 (38%). The treatment failed in 37/72 (51%). Conclusions: TPNS warrants consideration as a therapy for neuropathic pain in the upper limb after drug treatment has failed and before offering surgery or spinal root stimulation.

scholarly journals Elective amputation of the upper limb is an option in the treatment of traumatic injuries of the brachial plexus?

2017 ◽  
Vol 75 (9) ◽  
pp. 667-670 ◽  
Author(s):  
Mário Gilberto Siqueira ◽  
Roberto Sérgio Martins ◽  
Carlos Otto Heise ◽  
Luciano Foroni
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Limb Amputation ◽  
Brachial Plexus Palsy ◽  
Traumatic Injuries ◽  
Upper Limb Amputation ◽  
Pros And Cons ◽  
Post Traumatic ◽  
Active Patients

ABSTRACT The treatment of complete post-traumatic brachial plexus palsy resulting in a flail shoulder and upper extremity remains a challenge to peripheral nerve surgeons. The option of upper limb amputation is controversial and scarcely discussed in the literature. We believe that elective amputation still has a role in the treatment of select cases. The pros and cons of the procedure should be intensely discussed with the patient by a multidisciplinary team. Better outcomes are usually achieved in active patients who strongly advocate for the procedure.

scholarly journals One Year Follow-up of a Randomized, Double-Blind, Placebo-Controlled Trial of Percutaneous Peripheral Nerve Stimulation for Chronic Neuropathic Pain Following Amputation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Joshua M Rosenow ◽  
Christopher Gilmore ◽  
Brian M Ilfeld ◽  
Sean Li ◽  
Mehul J Desai ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Pain Interference ◽  
Controlled Study ◽  
Double Blind ◽  
Double Blind Placebo

Abstract INTRODUCTION Over 85% of patients experience residual limb (RLP) and/or phantom limb (PLP) pain following amputation. Peripheral nerve stimulation (PNS) is a non-opioid approach to relieve postamputation neuropathic pain. A recent multicenter, randomized, double-blind, placebo-controlled study using a novel percutaneous PNS system demonstrated clinically and statistically significant improvements in pain and pain interference with PNS compared to placebo (Gilmore et al, 2019). This work presents prospective 1-yr follow-up to assess durability of pain relief and functional improvements. METHODS Over 85% of patients experience residual limb (RLP) and/or phantom limb (PLP) pain following amputation. Peripheral nerve stimulation (PNS) is a non-opioid approach to relieve post-amputation neuropathic pain. A recent multicenter, randomized, double-blind, placebo-controlled study using a novel percutaneous PNS system demonstrated clinically and statistically significant improvements in pain and pain interference with PNS compared to placebo (Gilmore et al, 2019). This work presents prospective one-year follow-up to assess durability of pain relief and functional improvements. RESULTS A significantly greater proportion of subjects who completed the 12-mo visit reported = 50% pain relief on the BPI-SF (5/8, 63%; average pain relief = 73% among responders) compared to the placebo group at the time of crossover (0/14, 0%, P = .003; average pain relief = 23%). A majority of subjects also reported = 50% reductions in pain interference at 12 mo (5/8, 63%). Two of 13 (15%) subjects in the placebo group reported sustained improvements in pain interference (P = .06). Average reduction in pain interference among responders in the PNS group was 87%. CONCLUSION This work suggests that PNS delivered over 60 d may provide clinically significant and enduring pain relief, enabling improved function and potentially reducing the need for a permanently implanted system.

scholarly journals Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: a multicenter, randomized, placebo-controlled trial

2019 ◽  
Vol 44 (6) ◽  
pp. 637-645 ◽  
Author(s):  
Christopher Gilmore ◽  
Brian Ilfeld ◽  
Joshua Rosenow ◽  
Sean Li ◽  
Mehul Desai ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Pain Interference ◽  
Controlled Study ◽  
Chronic Neuropathic Pain ◽  
Postamputation Pain

Background and objectivesChronic neuropathic pain is a common challenging condition following amputation. Recent research demonstrated the feasibility of percutaneously implanting fine-wire coiled peripheral nerve stimulation (PNS) leads in proximity to the sciatic and femoral nerves for postamputation pain. A multicenter, double-blinded, randomized, placebo-controlled study collected data on the safety and effectiveness of percutaneous PNS for chronic neuropathic pain following amputation.MethodsTwenty-eight lower extremity amputees with postamputation pain were enrolled. Subjects underwent ultrasound-guided implantation of percutaneous PNS leads and were randomized to receive PNS or placebo for 4 weeks. The placebo group then crossed over and all subjects received PNS for four additional weeks. The primary efficacy endpoint evaluated the proportion of subjects reporting ≥50% pain reduction during weeks 1–4.ResultsA significantly greater proportion of subjects receiving PNS (n=7/12, 58%, p=0.037) demonstrated ≥50% reductions in average postamputation pain during weeks 1–4 compared with subjects receiving placebo (n=2/14, 14%). Two subjects were excluded from efficacy analysis due to eligibility changes. Significantly greater proportions of PNS subjects also reported ≥50% reductions in pain (n=8/12, 67%, p=0.014) and pain interference (n=8/10, 80%, p=0.003) after 8 weeks of therapy compared with subjects receiving placebo (pain: n=2/14, 14%; pain interference: n=2/13, 15%). Prospective follow-up is ongoing; four of five PNS subjects who have completed 12-month follow-up to date reported ≥50% pain relief.ConclusionsThis work demonstrates that percutaneous PNS therapy may provide enduring clinically significant pain relief and improve disability in patients with chronic neuropathic postamputation pain.Trial registration numberNCT01996254.

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