scholarly journals Interventional Treatments for Postherpetic Neuralgia: A Systematic Review

2019 ◽  
Vol 3 (22;3) ◽  
pp. 209-228 ◽  
Author(s):  
Chia-Shiang Lin
Keyword(s):  
Spinal Cord ◽  
Botulinum Toxin ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Postherpetic Neuralgia ◽  
Spinal Cord Stimulation ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Peripheral Nerve Stimulation ◽  
Ganglion Block

Background: Postherpetic neuralgia, a persistent pain condition often characterized by allodynia and hyperalgesia, is a deleterious consequence experienced by patients after an acute herpes zoster vesicular eruption has healed. The pain associated with postherpetic neuralgia can severely affect a patient’s quality of life, quality of sleep, and ability to participate in activities of daily living. Currently, first-line treatments for this condition include the administration of medication therapies such as tricyclic antidepressants, pregabalin, gabapentin, and lidocaine patches, followed by the application of tramadol and capsaicin creams and patches as second- or third-line therapies. As not all patients respond to such conservative options, however, interventional therapies are valuable for those who continue to experience pain. Objective: This review focuses on interventional therapies that have been subjected to randomized controlled trials for the treatment of postherpetic neuralgia, including transcutaneous electrical nerve stimulation; local botulinum toxin A, cobalamin, and triamcinolone injection; intrathecal methylprednisolone and midazolam injection; stellate ganglion block; dorsal root ganglion destruction; and pulsed radiofrequency therapy. Study Design: Systematic review Setting: Hospital department in Taiwan Methods: Search of PubMed database for all randomized controlled trials regarding postherpetic neuralgia that were published before the end of May 2017. Results: The current evidence is insufficient for determining the single best interventional treatment. Considering invasiveness, price, and safety, the subcutaneous injection of botulinum toxin A or triamcinolone, transcutaneous electrical nerve stimulation, peripheral nerve stimulation, and stellate ganglion block are recommended first, followed by paravertebral block and pulsed radiofrequency. If severe pain persists, spinal cord stimulation could be considered. Given the destructiveness of dorsal root ganglion and adverse events of intrathecal methylprednisolone injection, these interventions should be carried out with great care and only following comprehensive discussion. Limitations: Although few adverse effects were reported, these procedures are invasive, and a careful assessment of the risk-benefit ratio should be conducted prior to administration. Conclusion: With the exception of intrathecal methylprednisolone injection for postherpetic neuralgia, the evidence for most interventional procedures used to treat postherpetic neuralgia is Level 2, according to “The Oxford Levels of Evidence 2”. Therefore, these modalities have received only grade B recommendations. Despite the lack of a high level of evidence, spinal cord stimulation and peripheral nerve stimulation are possibly useful for the treatment of postherpetic neuralgia. Key words: Interventional treatment, postherpetic neuralgia, botulinum toxin, steroid, stellate ganglion block, peripheral nerve stimulation, paravertebral block, radiofrequency, spinal cord stimulation

Spinal Cord Stimulation and Peripheral Nerve Stimulation

Pain ◽  
2011 ◽  
pp. 148-154
Author(s):  
Tabitha A. Washington ◽  
Khalilah M. Brown ◽  
Gilbert J. Fanciullo
Keyword(s):  
Spinal Cord ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Spinal Cord Stimulation ◽  
Peripheral Nerve Stimulation

scholarly journals Peripheral Nerve Stimulation of the Lateral Femoral Cutaneous and Superior Gluteal Nerves for Treating Proximal Neuropathy Hip Pain

2020 ◽  
pp. 221-224
Author(s):  
Niek Vanquathem
Keyword(s):  
Drug Delivery ◽  
Spinal Cord ◽  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Spinal Cord Stimulation ◽  
Hip Pain ◽  
Peripheral Nerve Stimulation ◽  
Peripheral Neuropathic Pain ◽  
Intrathecal Drug Delivery

Background: Chronic postoperative hip pain is estimated to occur in 10% to 35% of patients undergoing total hip replacement. Proximal peripheral neuropathic pain of the lateral femoral cutaneous and superior gluteal nerves has proven to be a difficult disorder to treat. Opioids are often ineffective in the treatment of neuropathic pain. Interventional methods such as peripheral nerve stimulation are minimally invasive options capable of relieving neuropathic pain. Stimulators powered by an implantable pulse generator (IPG), however, may not be suitable for peripheral nerve stimulation because of difficulty finding an appropriate pocket site. The introduction of wireless peripheral nerve stimulation has improved the ability to offer this modality. Case Presentation: We present a case of proximal peripheral neuropathic pain of the lateral femoral cutaneous and superior gluteal nerves that failed all other treatment modalities including spinal cord stimulation and intrathecal drug delivery. Two quadripolar, tined, wireless electrode arrays were positioned over the lateral femoral cutaneous and superior gluteal nerves. A stimulation scheme with a pulse rate of 1.5 kHz and pulse width of 30 μs at 2.0 mA was tested and found effective. Conclusion: This patient had proximal neuropathic hip pain and failed a variety of chronic pain treatment options, including conventional IPG-based spinal cord stimulation and an intrathecal drug delivery system. She was successfully treated with a wireless peripheral nerve stimulation system. Key words: Hip pain, lateral femoral cutaneous nerve, peripheral nerve stimulator, peripheral neuropathy, superior gluteal nerve

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.

scholarly journals Combined Spinal Cord Stimulation and Peripheral Nerve Stimulation for Brachial Plexopathy: A Case Report

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E459-E463
Author(s):  
Ho Sik Moon
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Nerve Stimulation ◽  
Spinal Cord Stimulation ◽  
Rating Scale ◽  
Combined Treatment ◽  
Peripheral Nerve Stimulation ◽  
Brachial Plexopathy

Brachial plexopathy usually results from an iatrogenic brachial plexus injury and can sometimes cause severe chronic pain and disability. There are a number of possible treatments for this condition, including medication, physical therapy, nerve blocks, and neuromodulation, but they are not always successful. Recently, combined spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been tried for various chronic pain diseases because of their different mechanisms of action. Here, we describe the case of a 54-year-old man who was diagnosed with brachial plexopathy 8 years ago. He underwent video-assisted thoracoscopic surgery to remove a superior mediastinal mass. However, his brachial plexus was damaged during the surgery. Although he had received various treatments, the pain did not improve. For the management of intractable severe pain, he underwent SCS 2 years ago, which initially reduced his pain from numeric rating scale (NRS) 10/10 to NRS 4 – 5/10, but the pain then gradually increased, reaching NRS 8/10, 6 months ago. At that time, he was refractory to other treatments, and we therefore applied PNS in combination with SCS. The PNS electrode was positioned on the radial nerve under ultrasound guidance. After combined PNS and SCS, his background pain disappeared, although a breakthrough pain (NRS 3 – 4/10) was caused intermittently by light touch. Furthermore, the patient’s need for analgesics decreased, and he was satisfied with the outcome of this combined treatment. We concluded that combined SCS and PNS is a very useful treatment modality, which can stimulate the target nerve both directly and indirectly, and hence, relieve pain from brachial plexopathy. Key words: Brachial plexopathy, spinal cord, peripheral nerve, stimulation, ultrasound, neuropathic

scholarly journals Percutaneous peripheral nerve stimulation for treatment of shoulder pain after spinal cord injury: A case report

2017 ◽  
Vol 41 (1) ◽  
pp. 119-124 ◽  
Author(s):  
Daniela Mehech ◽  
Melvin Mejia ◽  
Gregory A. Nemunaitis ◽  
John Chae ◽  
Richard D. Wilson
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Case Report ◽  
Peripheral Nerve ◽  
Shoulder Pain ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Cord Injury
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