scholarly journals Ultrasound Guided Peripheral Nerve Stimulation Implant for Management of Intractable Pain after Inguinal Herniorrhaphy

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. E31-E38 ◽  
Author(s):  
Foad Elahi
Keyword(s):  
Inguinal Hernia ◽  
Pain Relief ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Case Series ◽  
Peripheral Nerve Stimulation ◽  
Intractable Pain ◽  
Ultrasound Guided ◽  
Inguinal Herniorrhaphy ◽  
Significant Pain

Background: Inguinal hernia repair is one of the most common operations performed worldwide. Intractable pain following this operation is a potential debilitating complication. The exact etiology of this complex pain is unknown and the treatment of chronic pain after inguinal herniorrhaphy can be a difficult task for both the patient and the clinician. Objectives: The objectives of this study are to identify the ability of peripheral nerve electrical stimulation to decrease post inguinal herniorrhaphy pain, increase patients’ functionality, and decrease pain medication use. Study Design: Three patients with intractable pain after inguinal herniorrhaphy were included in this case series. Two patients had right-sided inguinal repair and one had a leftsided repair. Pain in these patients all began after the inguinal repair and had an average pain duration of 3.4 years after surgery. All 3 patients had been treated with multiple pain management modalities without significant pain improvement. We will describe the clinical course of these patients who presented with chronic intractable pain. After a period of failed conservative medical management and repetitive successful nerve blocks, we decided to proceed with utilizing electrical nerve stimulation as a treatment modality. Setting: This retrospective study was done at the university hospital and has an IRB assigned number. Results: After careful consideration of the patients’ history and physical examination and a thorough psychological assessment, we proceeded with a temporary percutaneous electrical neurostimulation that provided significant pain relief. Ultrasound guided permanent percutaneous electrical neurostimulation implant was shown to provide significant pain relief at 12-month follow-ups. We reviewed all existing pertinent medical literature related to the management of post herniorrhaphy pain. This case series adds to our current knowledge for chronic intractable post herniorrhaphy pain management. Limitations: This study is a retrospective assessment of a new technique that was applied to a limited number of cases. It remains to be determined whether this technique is superior to the classical open surgical technique in the future. Our findings warrant further studies on the utilization of peripheral nerve stimulation with chronic post herniorrhaphy pain. Key words: Peripheral nerve stimulation, ilioinguinal nerve, iliohypogastric nerve, nerve block, inguinal hernia repair, ultrasound guided procedure

scholarly journals Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain

2012 ◽  
Vol 1;15 (1;1) ◽  
pp. 27-33 ◽  
Author(s):  
David A. Stidd
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Medical Management ◽  
Facial Pain ◽  
Case Series ◽  
Peripheral Nerve Stimulation ◽  
Intractable Pain ◽  
Safe Procedure ◽  
Trigeminal Neuropathic Pain

Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can be a condition difficult to adequately treat with medical management alone. Patients with TNP can suffer from significant morbidity as a result of inadequate treatment or the side effects of pharmacologic therapy. TNP refractory to medical management can be considered for treatment with a growing number of invasive procedures. Peripheral nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively treat medically intractable TNP. We present a case series of common causes of TNP successfully treated with PNS with up to a 2 year follow-up. Only one patient required implantation of new electrode leads secondary to electrode migration. The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management. Key words: Trigeminal neuropathic pain, peripheral nerve stimulation, neuromodulation, intractable pain, facial trauma, postherpetic neuralgia

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.

Ultrasound-Guided, Percutaneous Peripheral Nerve Stimulation: Technical Note

2010 ◽  
Vol 67 (3) ◽  
pp. ons136-ons139 ◽  
Author(s):  
Isaac Chan ◽  
Anthony R. Brown ◽  
Kenneth Park ◽  
Christopher J. Winfree
Keyword(s):  
Pain Relief ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Peripheral Nerve Stimulation ◽  
Electrode Position ◽  
Nerve Stimulator ◽  
Ultrasound Guided ◽  
Peripheral Nerve Stimulator ◽  
The Right

Abstract BACKGROUND: Peripheral nerve stimulation is a form of neuromodulation that applies electric current to peripheral nerves to induce stimulation paresthesias within the painful areas. OBJECTIVE: To report a method of ultrasound-guided, percutaneous peripheral nerve stimulation. This technique utilizes real-time imaging to avoid injury to adjacent vascular structures during minimally invasive placement of peripheral nerve stimulator electrodes. MATERIAL AND METHODS: We describe a patient that presented with chronic, bilateral foot pain following multiple foot surgeries, for whom a comprehensive, pain management treatment strategy had failed. We utilized ultrasound-guided, percutaneous tibial nerve stimulation at a thigh level to provide durable pain relief on the right side, and open peripheral nerve stimulation on the left. RESULTS: The patient experienced appropriate stimulation paresthesias and excellent pain relief on the plantar aspect of the right foot with the percutaneous electrode. On the left side, we were unable to direct the stimulation paresthesias to the sole of the foot, despite multiple electrode repositionings. A subsequent, open placement of a left tibial nerve stimulator was performed. This revealed that the correct electrode position against the tibial nerve was immediately adjacent to the popliteal artery, and was thus not appropriate for percutaneous placement. CONCLUSION: We describe a method of ultrasound-guided peripheral nerve stimulation that avoids the invasiveness of electrode placement via an open procedure while providing excellent pain relief. We further describe limitations of the percutaneous approach when navigating close to large blood vessels, a situation more appropriately managed with open peripheral nerve stimulator placement. Ultrasound-guided placement may be considered for patients receiving peripheral nerve stimulators placed within the deep tissues, and not easily placed in a blind fashion.

Combined Ultrasound and Fluoroscopic Guidance for Percutaneous Ilioinguinal Peripheral Nerve Stimulation

2017 ◽  
pp. 93-97
Author(s):  
Juan A. Ramos
Keyword(s):  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Large Scale ◽  
Imaging Modality ◽  
Peripheral Nerve Stimulation ◽  
Imaging Modalities ◽  
Intractable Pain ◽  
Fluoroscopic Guidance ◽  
Ilioinguinal Nerve ◽  
Inguinal Herniorrhaphy

Postprocedure surgical pain can progress from acute to an unyielding chronic pain pattern. Inguinal herniorrhaphy pain is one of the most common procedures to undergo this progression. Peripheral nerve field stimulation of the ilioinguinal nerve has been well documented as a successful means of treating this pain condition. Various imaging modalities have been utilized for placing the electrodes, including fluoroscopy and ultrasound, with each having specific advantages. A review of the literature did not show any prior documented combination of the two. We describe here combined fluoroscopic/ultrasound guidance for ilioinguinal nerve stimulation. A 59-year-old patient with intractable pain following inguinal herniorrhaphy underwent an ilioinguinal nerve stimulation trial with combined ultrasound and fluoroscopic guidance; he received significant relief during the trial period and was subsequently implanted permanently. Following implantation he obtained significant pain relief and ceased opioid and benzodiazepine use. The combination of the 2 imaging modalities allowed for easy identification of the relevant fascial layers for nerve localization, lead maneuverability, and pain coverage. The reliable identification of specific target nerves and electrode orientation helped to allow reproducibility from successful trial to permanent lead placement. Combined ultrasound and fluoroscopy use for Ilioinguinal nerve stimulation is feasible and provides anatomic reassurance; further research needs to be conducted to ascertain cost effectiveness and large-scale outcomes of this combined imaging modality. Limitations include the small number of cases and short outcome follow-up. Key words: Neuralgia, ilioinguinal, implantable neurostimulators, peripheral nerve stimulation, neuromodulation, neuropathic pain, ultrasound, fluoroscopy, combination technique

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

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

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.

scholarly journals Percutaneous Peripheral Nerve Stimulation to Control Postoperative Pain, Decrease Opioid Use, and Accelerate Functional Recovery Following Orthopedic Trauma

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 557-564 ◽  
Author(s):  
Brian M Ilfeld ◽  
Scott T Ball ◽  
Steven P Cohen ◽  
Steven R Hanling ◽  
Ian M Fowler ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Case Series ◽  
Opioid Therapy ◽  
Peripheral Nerve Stimulation ◽  
Orthopedic Trauma ◽  
Opioid Use ◽  
Postamputation Pain ◽  
Improved Function

Abstract Orthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy—percutaneous peripheral nerve stimulation (PNS) – and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.

scholarly journals Ultrasound-Guided Peripheral Nerve Stimulation for Knee Pain: A Mini-Review of the Neuroanatomy and the Evidence from Clinical Studies

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_1) ◽  
pp. S56-S63
Author(s):  
Chih-Peng Lin ◽  
Ke-Vin Chang ◽  
Wei-Ting Wu ◽  
Levent Özçakar
Keyword(s):  
Peripheral Nerve ◽  
Knee Pain ◽  
Nerve Stimulation ◽  
Case Reports ◽  
Case Series ◽  
Peripheral Nerve Stimulation ◽  
Present Review ◽  
Chronic Knee Pain ◽  
Catheter Dislodgement ◽  
Continuous Nerve Block

Abstract Objectives Peri- and postoperative pain frequently develops after joint replacement for severe knee osteoarthritis. A continuous nerve block is commonly used for pain relief, but the risks of infection and catheter dislodgement should be considered. The present mini-review aimed to brief the innervation and neural sonoanatomy of the knee joint and summarize the newest evidence of peripheral nerve stimulation (PNS) use in the management of knee pain. Methods We used a systematic approach to search for relevant articles. We used the combination of “peripheral nerve stimulation” and “knee pain” as the key words for the literature search using the electronic database without language or article type restriction. The search period was from the earliest record to August 2019. Results The present review identified six studies, four of which were related to PNS for management of postoperative knee pain and two of which probed neuropathic pain. Most of the studies were either case series or case reports. Based on our search result, PNS is likely to be a feasible and safe treatment for knee pain, but its effectiveness remains uncertain. Conclusions The present review reveals that PNS is feasible for the management of knee pain, especially in the postoperative period. The procedure is safe under ultrasound guidance used for proper placement of the electrodes near the target nerves. In the future, more prospective randomized controlled trials are needed to validate the effectiveness of PNS in acute and chronic knee pain.

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