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 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

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 Peripheral Nerve Stimulation of the Thoracic Paravertebral Plexus for Chronic Neuropathic Pain

2011 ◽  
Vol 3;14 (3;5) ◽  
pp. 295-300
Author(s):  
Dominic Hegarty
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
Surgical Pain ◽  
Increased Risk ◽  
Clinical Awareness ◽  
Term Management ◽  
Stimulation Of

Persistent post surgical pain is reported in 70% of patients following thoracotomy and mastectomy. This pain is often neuropathic in nature and occasionally it is refractory to traditional medical and interventional management. Neurostimulation of peripheral nerves can be a highly effective clinical modality for the management of neuropathic pain. The placement of a percutaneously sited electrode in the thoracic paravertebral plexus offers a new and novel mode of managing refractory thoracic neuropathic pain. We present 2 cases that demonstrate the effectiveness of this intervention in the long-term management of this clinical dilemma. The first case presented is that of a 61-year-old female, with unilateral neuropathic pain for 6 years following mastectomy refractory to traditional interventions. Targeted field stimulation of the thoracic paravertebral plexus resulted in significant improvement for 12 years. The second case is that of a 65-year-old male, with Type II diabetes with neuropathic thoracic pain for 6 years following multiple rib fractures (T4-T7) who responded positively to neurostimulation of the thoracic paravertebral plexus. Both of these cases demonstrate a relative reduction in pain intensity (> 80%), the elimination of oral analgesics, and improved functionality directly related to the novel use of this intervention. Effective and reproducible pain relief is achieved by specifically using a low frequency (10 Hz) and low amplitude (2 mA) stimulation technique. Equally important is that these cases highlight the increased risk of inadvertent pleural puncture with the development of a pneumothorax that can be associated with this intervention. Possible clinical, investigative and equipment modifications that need to be considered are discussed. The limitations include only 2 case reports, considered as the lowest level of evidence available in the era of evidence-based medicine, and lack of utilization of multiple other modalities of treatments utilized in managing neuropathic pain. In conclusion, these cases demonstrate the effectiveness of peripheral nerve stimulation of the thoracic paravertebral plexus in the long-term management of refractory neuropathic pain. They also serve to underline the importance of clinical awareness in order to improve patient safety. Key words: Peripheral nerve stimulation, thoracic paravertebral plexus, persistent post surgical pain, neuropathic pain, pneumothorax

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.

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