Using Peripheral Stimulation to Reduce the
Pain of C2-Mediated Occipital Headaches: A
Preliminary Report

Background: Peripheral nerve stimulation (PNS) is an accepted treatment for neuropathic pain. Recent studies have focused on its potential for relieving headache pain. Objectives: To investigate the effectiveness of PNS in reducing occipital headache pain. Design: A prospective, 12-week pilot study involving 11 patients evaluated before and after implantation of PNS systems to treat C2-mediated occipital headaches. Methods: Prior to and at 4 and 12 weeks after implantation, patients completed the Short-Form McGill Pain Questionnaire (SF-MPQ), Visual Analog Scale (VAS), and Present Pain Index (PPI). Patients also answered questionnaires and kept diaries to record stimulator use, medication consumption, and numbers of headaches. Results: A comparison of pre- and post-implantation evaluations showed statistically significant declines in scores on the SF-MPQ (64%; p = 0.0013), VAS (67%; p < 0.0001), and PPI (68%; p = 0.0009). Most patients (91% and 64% respectively) reported reductions in medication use and numbers of headaches. Patients also reported a reduction in headache symptoms and the impact of headaches on activities. Two adverse events were encountered, one due to a loose connection and, the other caused by lead migration. Conclusions: PNS reduced headache pain, headache frequency and medication use. Key words: peripheral nerve stimulation, PNS, peripheral nerve, occipital headache, headache pain

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

Pain Management Case Reports ◽

10.36076/pmcr.2021.5.201 ◽

2021 ◽

pp. 201-204

Keyword(s):

Case Report ◽

Pain Relief ◽

Peripheral Nerve ◽

Knee Pain ◽

Nerve Stimulation ◽

Short Form ◽

Pain Modulation ◽

Peripheral Nerve Stimulation ◽

Osteoarthritis Of The Knee ◽

Osteoarthritic Knee

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

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Feasibility of Combined Epicranial Temporal and Occipital Neurostimulation: Treatment of a Challenging Case of Headache

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/37 ◽

2011 ◽

Vol 1;14 (1;1) ◽

pp. 37-44

Author(s):

Kevin L . Wininger

Keyword(s):

Peripheral Nerve ◽

Nerve Stimulation ◽

Peripheral Nerve Stimulation ◽

Temporal Region ◽

Occipital Neuralgia ◽

Occipital Nerve Stimulation ◽

Case Presentation ◽

Adverse Side Effects ◽

Headache Pain

Background: Evidence of a paradigm shift towards epicranial neurostimulation treatment techniques aimed at the site of headache pain is beginning to populate the literature. This is most apparent by 2 recently published reports describing alternative approaches to peripheral nerve stimulation techniques for refractory migraine, including hemiplegic migraine. Objectives: To contribute to the emerging literature on epicranial-based neuroaugmentative approaches which target site-specific areas of distinct, but relatively diffuse, headache pain. Specifically, we describe the feasibility of a novel neurostimulation technique: occipital nerve stimulation, combined with bilateral subcutaneous electrical stimulation over the temporal region, to treat a patient dually diagnosed with “complicated migraine” and occipital neuralgia. Integral to this report, key stimulation programming data are also presented to better distinguish the role of this form of therapy in migraine, or other headache forms, from both the clinical and biomedical perspectives. Methods: Case presentation with literature review. Results: At 24-month follow-up, headache onset had been reduced by more than 50%, including cessation of neurologic deficits that accompanied the patient’s migraines. No complications or adverse side effects are reported. The programming data reported here supports a proposed mechanism of action concerning stimulation of the auriculotemporal nerve distribution/anterior temporal region for management of refractory pain in migraine. Limitations: Case presentation provides only initial assessment of treatment safety, not conclusive evidence of treatment effectiveness. Future studies which consider “followthe-path” epicranial approaches to peripheral nerve stimulation techniques for refractory headache pain are needed to better quantify outcomes and mechanisms of action. Conclusions: In the single case reported here, the feasibility of a novel neurostimulation technique (occipital nerve stimulation/bilateral subcutaneous temporal region stimulation) to treat headache is presented. At the 24-month follow-up, no complications (such as loss of coverage due to lead displacement or lead fracture or erosion) or adverse side effects were reported. Finally, inclusion of fundamental programming data in reports on neuroaugmentative approaches to headache care will complement initiatives in research from the clinical and biomedical communities involved in this field. Key words: Epicranial neurostimulation technique, peripheral nerve stimulation, stimulation parameters, complicated migraine, occipital neuralgia.

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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

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100937 ◽

2019 ◽

Vol 45 (1) ◽

pp. 44-51 ◽

Cited By ~ 4

Author(s):

Christopher A Gilmore ◽

Brian M Ilfeld ◽

Joshua M Rosenow ◽

Sean Li ◽

Mehul J Desai ◽

...

Keyword(s):

Chronic Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Short Form ◽

Peripheral Nerve Stimulation ◽

Pain Interference ◽

Phantom Limb ◽

Group 2 ◽

Group 1

IntroductionPeripheral nerve stimulation (PNS) has historically been used to treat chronic pain, but generally requires implantation of a permanent system for sustained relief. A recent study found that a 60-day PNS treatment decreases post-amputation pain, and the current work investigates longer-term outcomes out to 12 months in the same cohort.MethodsAs previously reported, 28 traumatic lower extremity amputees with residual and/or phantom limb pain were randomized to receive 8 weeks of PNS (group 1) or 4 weeks of placebo followed by a crossover 4 weeks of PNS (group 2). Percutaneous leads were implanted under ultrasound guidance targeting the femoral and sciatic nerves. During follow-up, changes in average pain and pain interference were assessed using the Brief Pain Inventory–Short Form and comparing with baseline.ResultsSignificantly more participants in group 1 reported ≥50% reductions in average weekly pain at 12 months (67%, 6/9) compared with group 2 at the end of the placebo period (0%, 0/14, p=0.001). Similarly, 56% (5/9) of participants in group 1 reported ≥50% reductions in pain interference at 12 months, compared with 2/13 (15%, p=0.074) in group 2 at crossover. Reductions in depression were also statistically significantly greater at 12 months in group 1 compared with group 2 at crossover.ConclusionsThis work suggests that percutaneous PNS delivered over a 60-day period may provide significant carry-over effects including pain relief, potentially avoiding the need for a permanently implanted system while enabling improved function in patients with chronic pain.Trial registration numberNCT01996254.

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The Impact of Peripheral Nerve Stimulation on Disability and Depression

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.12363 ◽

2015 ◽

Vol 19 (3) ◽

pp. 306-310

Author(s):

Tina Ramineni ◽

Julia Prusik ◽

Priscilla De La Cruz ◽

Lucy Gee ◽

Vignessh Kumar ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Stimulation ◽

Peripheral Nerve Stimulation ◽

The Impact

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Peripheral Stimulation for Treatment of Trigeminal Postherpetic Neuralgia and Trigeminal Posttraumatic Neuropathic Pain: A Pilot Study

Neurosurgery ◽

10.1227/01.neu.0000126874.08468.89 ◽

2004 ◽

Vol 55 (1) ◽

pp. 135-142 ◽

Cited By ~ 137

Author(s):

Mark D. Johnson ◽

Kim J. Burchiel

Keyword(s):

Pain Relief ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Postherpetic Neuralgia ◽

Medication Use ◽

Peripheral Nerve Stimulation ◽

Facial Trauma ◽

Herpetic Infection ◽

Peripheral Stimulation ◽

Stimulation Of

Abstract OBJECTIVE: Trigeminal neuropathic pain (TNP) after facial trauma or herpes zoster infection is often refractory to treatment. Peripheral nerve stimulation has been used to treat occipital neuralgia; however, efficacy in controlling facial TNP or postherpetic neuralgia is unknown. A retrospective case series of patients who underwent subcutaneous placement of stimulating electrodes for treatment of V1 or V2 TNP secondary to herpetic infection or facial trauma is presented. METHODS: Ten patients received implanted subcutaneous pulse generators and quadripolar electrodes for peripheral stimulation of the trigeminal nerve supraorbital or infraorbital branches. Long-term treatment results were determined by retrospective review of medical records (1998–2003) and by independent observers interviewing patients using a standard questionnaire. Surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of therapy satisfaction were assessed. Mean follow-up was 26.6 ± 4.7 months. RESULTS: Peripheral nerve stimulation provided at least 50% pain relief in 70% of patients with TNP or postherpetic neuralgia. Medication use declined in 70% of patients, and 80% indicated that they were mostly or completely satisfied with treatment overall. There were no treatment failures (< 50% pain relief and a lack of decrease in medication use) in the posttraumatic group, and two failures (50%) occurred in the postherpetic group. The complication rate requiring reoperation was 30%. CONCLUSION: Peripheral nerve stimulation of the supraorbital or infraorbital branches of the trigeminal nerve is an effective method for relief of TNP after facial trauma or herpetic infection. A prospective trial using this novel approach to treat these disorders is thus warranted.

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Enhancing osteoblast survival through pulsed electrical stimulation and implications for osseointegration

Scientific Reports ◽

10.1038/s41598-021-01901-3 ◽

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.

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