scholarly journals Peripheral Field Nerve Stimulation in Refractory Subcutaneous Persistent Postsurgical Pain

2021 ◽  
pp. 85-88
Author(s):  
Benjamin S. Chaney
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Nerve Stimulation ◽  
Spinal Cord Stimulation ◽  
Intractable Pain ◽  
Electric Stimulation Therapy ◽  
Nerve Stimulator ◽  
Thoracic Pain ◽  
Transcutaneous Electric Nerve Stimulation ◽  
Refractory Pain

Background: The mechanistic underpinnings of nerve stimulation technology is an area of active debate in interventional pain literature. Whether the technology is transcutaneous, subcutaneous, or directly on the spinal cord/dorsal root ganglion, there are ample theories without substantive evidence. Although, these technologies have been proven to be invaluable for pain relief. Direct spinal cord stimulation is purported to be effective for peripheral pain through centrally mediated stimulation. However, in select cases, there is evidence for superior analgesia from a peripherally directed device, such as a subcutaneously placed peripheral field nerve stimulator (PFNS), when compared to spinal cord stimulators (SCS). Case Report: An 81-year-old man was referred for left upper thoracic pain exacerbated by lipoma excision with diagnostic imaging unsupportive of musculoskeletal etiology. The patient was found to have soft tissue tenderness to palpation worsened by activity. He failed numerous conservative treatments and procedures. An epidural SCS was trialed, with appropriate paresthesia mapping, but was unsuccessful in providing significant relief. Ultimately, a PFNS was trialed and found to provide adequate relief. A PFNS was later implanted, resulting in successful pain relief. Conclusion: The case demonstrates the importance of developing evidence-based guidelines for the application of PFNS. Additionally, it is important to delineate the shared and unique targets of nerve stimulator technologies so that patients may minimize risk through trial-and-error procedures. Key words: Surgical procedures, operative, spinal cord stimulation, refractory pain, paroxysmal nerve pain, intractable pain, electric stimulation therapy, back pain without radiation,transcutaneous electric nerve stimulation

scholarly journals Paresthesia-Independence: An Assessment of Technical Factors Related to 10 kHz Paresthesia-Free Spinal Cord Stimulation

2017 ◽  
Vol 4 (20;4) ◽  
pp. 331-341
Author(s):  
Kerry Bradley
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Study Design ◽  
Spinal Cord Stimulation ◽  
Pulse Generator ◽  
Pain Clinic ◽  
Leg Pain ◽  
Controlled Study ◽  
Intractable Pain ◽  
Technical Factors

Background: Spinal cord stimulation (SCS) has been successfully used to treat chronic intractable pain for over 40 years. Successful clinical application of SCS is presumed to be generally dependent on maximizing paresthesia-pain overlap; critical to achieving this is positioning of the stimulation field at the physiologic midline. Recently, the necessity of paresthesia for achieving effective relief in SCS has been challenged by the introduction of 10 kHz paresthesia-free stimulation. In a large, prospective, randomized controlled pivotal trial, HF10 therapy was demonstrated to be statistically and clinically superior to paresthesia-based SCS in the treatment of severe chronic low back and leg pain. HF10 therapy, unlike traditional paresthesia-based SCS, requires no paresthesia to be experienced by the patient, nor does it require paresthesia mapping at any point during lead implant or post-operative programming. Objectives: To determine if pain relief was related to technical factors of paresthesia, we measured and analyzed the paresthesia responses of patients successfully using HF10 therapy. Study Design: Prospective, multicenter, non-randomized, non-controlled interventional study. Setting: Outpatient pain clinic at 10 centers across the US and Italy. Methods: Patients with both back and leg pain already implanted with an HF10 therapy device for up to 24 months were included in this multicenter study. Patients provided pain scores prior to and after using HF10 therapy. Each patient’s most efficacious HF10 therapy stimulation program was temporarily modified to a low frequency (LF; 60 Hz), wide pulse width (~470 μs), paresthesiagenerating program. On a human body diagram, patients drew the locations of their chronic intractable pain and, with the modified program activated, all regions where they experienced LF paresthesia. Paresthesia and pain drawings were then analyzed to estimate the correlation of pain relief outcomes to overlap of pain by paresthesia, and the mediolateral distribution of paresthesia (as a surrogate of physiologic midline lead positioning). Results: A total of 61 patients participated across 11 centers. Twenty-eight men and 33 women with a mean age of 56 ± 12 years of age participated in the study. The average duration of implantable pulse generator (IPG) implant was 19 ± 9 months. The average predominant pain score, as measured on a 0 – 10 visual analog scale (VAS), prior to HF10 therapy was 7.8 ± 1.3 and at time of testing was 2.5 ± 2.1, yielding an average pain relief of 70 ± 24%. For all patients, the mean paresthesia coverage of pain was 21 ± 28%, with 43% of patients having zero paresthesia coverage of pain. Analysis revealed no correlation between percentage of LF paresthesia overlap of predominant pain and HF10 therapy efficacy (P = 0.56). Exact mediolateral positioning of the stimulation electrodes was not found to be a statistically significant predictor of pain relief outcomes. Limitations: Non-randomized/non-controlled study design; short-term evaluation; certain technical factors not investigated.Conclusion: Both paresthesia concordance with pain and precise midline positioning of the stimulation contacts appear to be inconsequential technical factors for successful HF10 therapy application. These results suggest that HF10 therapy is not only paresthesia-free, but may be paresthesia-independent. Key words: Spinal cord stimulation, paresthesia, high frequency, 10kHz, pain relief, physiologic midline, paresthesia-free

scholarly journals Case Report: Short-Term Spinal Cord Stimulation and Peripheral Nerve Stimulation for the Treatment of Trigeminal Postherpetic Neuralgia in Elderly Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Lin Zhao ◽  
Tao Song
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Elderly Patients ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Postherpetic Neuralgia ◽  
Spinal Cord Stimulation ◽  
Short Term ◽  
Maxillary Nerve ◽  
High Cervical

Objective: We aimed to report on the use of short-term high cervical spinal cord stimulation (SCS) combined with peripheral nerve stimulation (PNS) to successfully treat trigeminal postherpetic neuralgia (TPHN) affecting the V2 and V3 divisions. We also sought to use a novel PNS approach to the maxillary nerve next to the external opening of the foramen rotundum (FR) to treat TPHN at the V2 division.Method: Two elderly patients successfully treated with different neuromodulation methods for TPHN are presented in this case series.Results: The first case referred to an 83-year-old Chinese female patient with V2 and V3 TPHN who experienced a significant pain relief using a combination of short-term high cervical SCS at the C1–C2 level and PNS on the infraorbital nerve (ION). Case 2 was a 68-year-old Chinese male patient with V1 and V2 TPHN that obtained an excellent pain relief after having received short-term PNS on the supraorbital nerve (SON), the supratrochlear nerve (STN), and the maxillary nerve. Both reported improvements in their quality of life and ability to perform daily tasks during a 3-month follow-up period.Conclusions: Short-term high cervical SCS at the C1–C2 spinal segments may be a feasible method to treat recent-onset V3 TPHN in elderly patients. Additionally, by placing the stimulation lead next to the external FR opening, we demonstrated a novel PNS approach to the maxillary nerve not previously reported for TPHN therapy.

Spinal cord stimulation in the treatment of paraplegic pain

1995 ◽  
Vol 82 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Beatrice Cioni ◽  
Mario Meglio ◽  
Luigi Pentimalli ◽  
Massimiliano Visocchi
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Neurological Status ◽  
Intractable Pain ◽  
Content Type ◽  
Number Of Patients ◽  
Status Level

✓ Twenty-five patients suffering from intractable pain due to a chronic spinal cord lesion underwent a percutaneous test of spinal cord stimulation. At the end of the test period, 40.9% of the patients reported a mean of 65% pain relief and these patients were selected for ongoing stimulation. At a mean follow-up time of 37.2 months the success rate, based on the number of patients with more than 50% pain relief, had fallen to 18.2%. Pain relief rates were analyzed in relation to quality of pain, neurological status, level and extent of the lesion, and electrode level to identify prognostic factors that could improve the clinical usefulness of spinal cord stimulation. Patients experiencing painful spasms or a constrictive type of pain and with incomplete thoracic lesions were found to be the best candidates for spinal cord stimulation.

scholarly journals Spinal Cord Stimulation Inhibits Cortical Somatosensory Evoked Potentials Significantly Stronger than Transcutaneous Electrical Nerve Stimulation

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. 405-414
Author(s):  
Tilman Wolter
Keyword(s):  
Spinal Cord ◽  
Nervous System ◽  
Pain Relief ◽  
Evoked Potentials ◽  
Nerve Stimulation ◽  
Somatosensory Evoked Potentials ◽  
Spinal Cord Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Dose Dependency ◽  
Electrical Nerve Stimulation

Background: Despite the good clinical results elicited by spinal cord stimulation (SCS), the physiological basis of action of SCS is widely unknown. Inhibition of somatosensory evoked potential (SEP) amplitudes by SCS has been described, but it is unclear whether this displays dose dependency. Moreover, it is unknown whether the pain-relieving effect elicited by SCS correlates with the inhibition of SEPs. Finally, this study aimed to answer the question whether there is a difference in the effect on SEPs between SCS and transcutaneous electrical nerve stimulation (TENS), thus between central nervous system stimulation and peripheral nervous system stimulation. Methods: Ten patients (4 men and 6 women, age range 40-77 years) with neuropathic lower limb pain were included in the study. All patients had implanted SCS systems with percutaneous type electrodes. Cortical SEPs under SCS and TENS were measured without stimulation, under stimulation at perception threshold (PT), and at maximal threshold (MT) in a crossover design. Results: Cortical SEP amplitudes were significantly inhibited by SCS. Stimulation at PT and at MT both led to a statistically significant inhibition of the SEP amplitude. The difference between amplitude reduction at PT and MT showed a tendency towards significance. The degree of SEP amplitude inhibition did not correlate with pain relief. Inhibition of SEP amplitudes by TENS was weaker than that elicited by SCS. The average percentage of amplitude reduction at MT was twice as high under SCS as it was under TENS. No effects on SEP latencies were seen. Conclusions: SCS exerts a significantly stronger inhibition of SEP amplitudes than TENS. The data hint at a dose dependency of SCS-induced SEP amplitude inhibition. No correlation between SEP amplitude inhibition and pain relief was found. Key words: spinal cord stimulation, SCS, transcutaneous electrical nerve stimulation, TENS, neuropathic pain, somatosensory evoked potentials, SEP

scholarly journals Comparing Effectiveness of Standard vs HF10 Spinal Cord Stimulator Implants for Chronic Intractable Pain

2021 ◽  
pp. 37-44
Author(s):  
Manasi Parikh
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency Stimulation ◽  
Intractable Pain ◽  
Male Population ◽  
Key Words Complications ◽  
Refractory Pain ◽  
Real World Evidence ◽  
Frequency Stimulation ◽  
One Year

Background: There is limited real-world evidence regarding the long-term effectiveness and safety outcomes related to spinal cord stimulation (SCS) for patients with chronic refractory pain. Case Report: This study included a total of 132 patients (73 had HF10); 53% was female. Mean Pretrial Numeric Pain Score for all patients was 8.4 ± 1.1 which decreased to 4.4 ± 2.0 at the end of one year (P < 0.0001). A 6% decrease in the percent of responders, between one month and one-year post-implant, was noted in the HF10 SCS compared to the 15% in standard SCS. A statistically significant decrease in pain relief in the male population (P = 0.02) and obese patients (P = 0.002) was observed. Most common complications: “IPG malfunction” (17%) for standard SCS and “IPG site pain” (12%) for HF10 SCS. Conclusion: HF10 SCS is a viable alternative to standard SCS for chronic intractable pain conditions. Key words: Complications, HF10, high-frequency stimulation, neuromodulation, patient outcomes, spinal cord stimulation

scholarly journals High Frequency Spinal Cord Stimulation at 10 kHz for the Treatment of Chronic Pain: 6-Month Australian Clinical Experience

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. 267-280 ◽  
Author(s):  
Dr Marc A. Russo
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Leg Pain ◽  
Control Group ◽  
Intractable Pain ◽  
Positive Trial ◽  
Pain Clinics ◽  
Wide Range

Background: High frequency spinal cord stimulation at 10 kHz (HF10 therapy) represents a prominent advance in spinal cord stimulation (SCS) therapy, having demonstrated enhanced efficacy in patients with back and leg pain and pain relief without paresthesia that is sustained at 24 months post implant. Objective: To report on the effectiveness HF10 SCS therapy for a wide range of intractable pain conditions in clinical practice. Study Design: Retrospective investigation of 256 patients who trialed HF10 SCS for chronic intractable pain of various etiologies. Setting: Three Australian pain clinics. Methods: Two hundred fifty-six patients trialed HF10 SCS with view of a permanent implant if successful. Pain distributions included back + leg, back only, head ± neck, and neck ± arm/ shoulder. About 30% of patients had previously failed traditional low-frequency paresthesiabased stimulation, while the remaining cohort were either highly refractory to treatment or not recommended by the pain physician for traditional SCS. Pain scores (numerical pain rating scale – NPRS) and functional outcome measures (Oswestry Disability Index – ODI; and activity tolerance times) were assessed at baseline, post-trial, and at 3 and 6 months post-implant as available in the medical records. Results: Of the 256 patients, 189 (73%) reported a positive trial and were implanted. Patients with back + leg pain demonstrated the highest trial success rate (81%). A mean reduction in pain, among those for whom data were available, of 50% was sustained up to 6 months postimplant across the entire patient population. Sixty-eight percent of patients who failed traditional SCS reported a positive trial and mean pain relief at 6 months was 49% (P < 0.001). An 8.6 point reduction in ODI (21%) at 6 months and improved sitting, standing, and walking tolerances were also reported. Limitations: As data was collected retrospectively, missing data points were unavoidable; this was primarily due to inconsistent data collection and patients being lost to follow-up. Patient populations were diverse and a control group was not appropriate in this setting. Conclusions: These retrospective results demonstrate a significant advancement for patients suffering with chronic intractable pain and are consistent with recently published clinical results for HF10 SCS. HF10 SCS appears to be a viable, paresthesia-free alternative to traditional SCS, with high trial success rates, demonstrated effectiveness in a range of pain distributions including those typically difficult to treat with traditional SCS, and the possibility to restore pain control in patients who have previously failed traditional SCS. Key words: Spinal cord stimulation, high frequency stimulation, HF10, paresthesia-free stimulation, back pain, leg pain, cervical pain, neuromodulation

Spinal Cord Stimulation: A Contemporary Series

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Roberto Spiegelmann ◽  
William A. Friedman
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Literature Review ◽  
General Anesthesia ◽  
Detailed Analysis ◽  
Spinal Cord Stimulation ◽  
Significant Pain ◽  
Experience Pain

Abstract Forty-three patients with chronic pain disorders of different causes were selected for spinal cord stimulation. All underwent implantation of a ribbon electrode through a small laminotomy, under general anesthesia. Thirteen patients (30%) failed to obtain significant pain relief during a period of trial stimulation, and their electrodes were removed. The remainder underwent a definitive implant and were followed for a mean of 13 months (range, 3-33 months). Nineteen of them (63%) continued to experience pain relief. A detailed analysis of this series, as well as a literature review, is presented.

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