scholarly journals Peripheral Nerve Stimulation: The Evolution in Pain Medicine

Biomedicines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 18
Author(s):  
Alaa Abd-Elsayed ◽  
Ryan S. D’Souza
Keyword(s):  
Electrical Stimulation ◽  
Peripheral Nerve ◽  
Mechanism Of Action ◽  
Nerve Stimulation ◽  
Peripheral Nerves ◽  
Peripheral Nerve Stimulation ◽  
Pain Medicine ◽  
Nervous Systems ◽  
Pulse Generators ◽  
Implantation Techniques

Peripheral nerve stimulation (PNS) involves the application of electrical stimulation near the proximity of peripheral nerves. Although the mechanism of action remains unknown, PNS likely modulates both the central and peripheral nervous systems to provide analgesia for a wide variety of pain disorders involving the head, extremities, and trunk. Historically, PNS was not utilized widely due to underwhelming results from earlier studies. However, significant innovations in device technologies, including improved implantation techniques, hardware miniaturization, and externalized pulse generators, have led to the resurgence of PNS in the field of pain medicine. This editorial briefly reviews the evolution of PNS in the field of pain medicine and highlights areas for future investigation.

Cadaveric Model Simulations for Training in Ultrasound-Guided Percutaneous Placement of a Novel Peripheral Nerve Stimulation Electrode

2021 ◽  
Author(s):  
Roberto Gazzeri ◽  
Alessandro Cesaroni ◽  
Ezio Amorizzo ◽  
Emanuele Piraccini ◽  
Fabrizio Micheli ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Peripheral Nerves ◽  
Peripheral Nerve Stimulation ◽  
Electrode Placement ◽  
Surgical Approaches ◽  
Ultrasound Guided ◽  
Model Simulations ◽  
Cadaveric Model ◽  
Stimulation Electrode

Peripheral nerve stimulation (PNS) electrodes are used to treat intractable painful conditions involving peripheral nerves. Methods for performing PNS continue to evolve, from open surgical to minimally invasive placement of electrodes. A PNS system consisting of subcutaneously implanted leads with an integrated anchor and electrodes, and an external pulse generator to produce peripheral neuromodulation, is now available for use in the clinical setting. This novel system allows either surgical or percutaneous lead positioning, and avoids the use of long leads or extensions crossing the joints, which are exposed to mechanical stress and damage. To identify methods for successfully inserting these electrodes, we investigated if a cadaver model could be an effective educational tool for teaching PNS electrode placement using ultrasound guidance. Six cadavers were studied in an attempt to find an ideal approach for ultrasound-guided electrode placement into the upper and lower extremities and cervical spine, and to describe the unique anatomy of the peripheral nerves relative to percutaneous stimulation-electrode placement. The use of cadaveric model simulations offers opportunities to practice percutaneous placement of PNS electrodes under stress-free conditions without patient discomfort, to acquire skill and confidence in performing these surgical approaches. Ultrasound-guided percutaneous placement of PNS electrodes should be learned in a simulation laboratory before such placement is performed in actual patients.

scholarly journals Improved Functional Outcome After Peripheral Nerve Stimulation of the Impaired Forelimb Post-stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Shih-Yen Tsai ◽  
Jennifer A. Schreiber ◽  
Natalie S. Adamczyk ◽  
Joanna Y. Wu ◽  
Son T. Ton ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Electrical Stimulation ◽  
Peripheral Nerve ◽  
Functional Outcome ◽  
Median Nerve ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Post Stroke ◽  
Axonal Tracing

Lack of blood flow to the brain, i.e., ischemic stroke, results in loss of nerve cells and therefore loss of function in the effected brain regions. There is no effective treatment to improve lost function except restoring blood flow within the first several hours. Rehabilitation strategies are widely used with limited success. The purpose of this study was to examine the effect of electrical stimulation on the impaired upper extremity to improve functional recovery after stroke. We developed a rodent model using an electrode cuff implant onto a single peripheral nerve (median nerve) of the paretic forelimb and applied daily electrical stimulation. The skilled forelimb reaching test was used to evaluate functional outcome after stroke and electrical stimulation. Anterograde axonal tracing from layer V pyramidal neurons with biotinylated dextran amine was done to evaluate the formation of new neuronal connections from the contralesional cortex to the deafferented spinal cord. Rats receiving electrical stimulation on the median nerve showed significant improvement in the skilled forelimb reaching test in comparison with stroke only and stroke with sham stimulation. Rats that received electrical stimulation also exhibited significant improvement in the latency to initiate adhesive removal from the impaired forelimb, indicating better sensory recovery. Furthermore, axonal tracing analysis showed a significant higher midline fiber crossing index in the cervical spinal cord of rats receiving electrical stimulation. Our results indicate that direct peripheral nerve stimulation leads to improved sensorimotor recovery in the stroke-impaired forelimb, and may be a useful approach to improve post-stroke deficits in human patients.

scholarly journals Enhancing osteoblast survival through pulsed electrical stimulation and implications for osseointegration

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emily Pettersen ◽  
Furqan A. Shah ◽  
Max Ortiz-Catalan
Keyword(s):  
Electrical Stimulation ◽  
Peripheral Nerve ◽  
Cell Survival ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Dependent Manner ◽  
Stimulation Parameters ◽  
Wide Range ◽  
The Impact

AbstractElectrical stimulation has been suggested as a means for promoting the direct structural and functional bonding of bone tissue to an artificial implant, known as osseointegration. Previous work has investigated the impact of electrical stimulation in different models, both in vitro and in vivo, using various electrode configurations for inducing an electric field with a wide range of stimulation parameters. However, there is no consensus on optimal electrode configuration nor stimulation parameters. Here, we investigated a novel approach of delivering electrical stimulation to a titanium implant using parameters clinically tested in a different application, namely peripheral nerve stimulation. We propose an in vitro model comprising of Ti6Al4V implants precultured with MC3T3-E1 preosteoblasts, stimulated for 72 h at two different pulse amplitudes (10 µA and 20 µA) and at two different frequencies (50 Hz and 100 Hz). We found that asymmetric charge-balanced pulsed electrical stimulation improved cell survival and collagen production in a dose-dependent manner. Our findings suggest that pulsed electrical stimulation with characteristics similar to peripheral nerve stimulation has the potential to improve cell survival and may provide a promising approach to improve peri-implant bone healing, particularly to neuromusculoskeletal interfaces in which implanted electrodes are readily available.

scholarly journals Current Innovations in Peripheral Nerve Stimulation

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Raghavendra Nayak ◽  
Ratan K. Banik
Keyword(s):  
Chronic Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Pain Syndrome ◽  
Peripheral Nerve Stimulation ◽  
Intractable Pain ◽  
Nerve Blocks ◽  
Pulse Generators ◽  
Cranial Neuralgias ◽  
Chronic Pain Conditions

Peripheral nerve stimulation has been used in the treatment of several chronic pain conditions including pain due to peripheral nerve dysfunctions, complex regional pain syndrome, and cranial neuralgias. It has been shown to be effective for chronic, intractable pain that is refractory to conventional therapies such as physical therapy, medications, transcutaneous electrical stimulations, and nerve blocks. Recently, a new generation of peripheral nerve stimulation devices has been developed; these allow external pulse generators to transmit impulses wirelessly to the implanted electrode, and their implantation is significantly less invasive. In this review, we discuss the history, pathophysiology, indications, implantation process, and outcomes of employing peripheral nerve stimulation to treat chronic pain conditions.

scholarly journals Noninvasive Stimulation of Peripheral Nerves using Temporally-Interfering Electrical Fields

2021 ◽  
Author(s):  
Boris Botzanowski ◽  
Mary J Donahue ◽  
Malin Silvera Ejneby ◽  
Alessandro L. Gallina ◽  
Ibrahima Ngom ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Peripheral Nerves ◽  
Sine Wave ◽  
Multielectrode Arrays ◽  
Bioelectronic Medicine ◽  
Nerve Model ◽  
Stimulation Of

Electrical stimulation of peripheral nerves is a cornerstone of bioelectronic medicine. Effective ways to accomplish peripheral nerve stimulation noninvasively without surgically implanted devices is enabling for fundamental research and clinical translation. Here we demonstrate how relatively high frequency sine-wave carriers (3 kHz) emitted by two pairs of cutaneous electrodes can temporally interfere at deep peripheral nerve targets. The effective stimulation frequency is equal to the offset frequency (0.5 - 4 Hz) between the two carriers. We validate this principle of temporal interference nerve stimulation (TINS) in vivo using the murine sciatic nerve model. Effective actuation is delivered at significantly lower current amplitudes than standard transcutaneous electrical stimulation. Further, we demonstrate how flexible and conformable on-skin multielectrode arrays can facilitate precise alignment of TINS onto a nerve. Our method is simple, relying on repurposing of existing clinically-approved hardware. TINS opens the possibility of precise noninvasive stimulation with depth and efficiency previously impossible with transcutaneous techniques.

Mechanism of Action of Peripheral Nerve Stimulation

2021 ◽  
Vol 25 (7) ◽  
Author(s):  
Natalie H. Strand ◽  
Ryan D’Souza ◽  
Christopher Wie ◽  
Stephen Covington ◽  
Moustafa Maita ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Mechanism Of Action ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation
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