High-frequency peripheral electric nerve block to treat postamputation pain

Soin, Amol; Fang, Zi-Ping; Velasco, Jon; Shah, Nemeth; Guirguis, Maged; Mekhail, Mena

doi:10.1053/j.trap.2015.10.016

Cited by 2 publications

(24 citation statements)

References 13 publications

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“…In addition, high frequency AC stimulation that exceed the kinetics of the ion channels in the cell membrane, will result in significantly higher voltage thresholds (such as ~45 Vpp at 500 kHz). In fact, pure sinusoidal AC continuous waveforms up to 40 kHz have been used effectively in nerve conduction block applications, such as relief from phantom limb pain [ 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Remote Stimulation of Sciatic Nerve Using Cuff Electrodes and Implanted Diodes

Sridharan¹,

Chirania²,

Towe³

et al. 2018

Micromachines

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We demonstrate a method of neurostimulation using implanted, free-floating, inter-neural diodes. They are activated by volume-conducted, high frequency, alternating current (AC) fields and address the issue of instability caused by interconnect wires in chronic nerve stimulation. The aim of this study is to optimize the set of AC electrical parameters and the diode features to achieve wireless neurostimulation. Three different packaged Schottky diodes (1.5 mm, 500 µm and 220 µm feature sizes) were tested in vivo (n = 17 rats). A careful assessment of sciatic nerve activation as a function of diode–dipole lengths and relative position of the diode was conducted. Subsequently, free-floating Schottky microdiodes were implanted in the nerve (n = 3 rats) and stimulated wirelessly. Thresholds for muscle twitch responses increased non-linearly with frequency. Currents through implanted diodes within the nerve suffer large attenuations (~100 fold) requiring 1–2 mA drive currents for thresholds at 17 µA. The muscle recruitment response using electromyograms (EMGs) is intrinsically steep for subepineurial implants and becomes steeper as diode is implanted at increasing depths away from external AC stimulating electrodes. The study demonstrates the feasibility of activating remote, untethered, implanted microscale diodes using external AC fields and achieving neurostimulation.

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Section: Discussionmentioning

confidence: 99%

Remote Stimulation of Sciatic Nerve Using Cuff Electrodes and Implanted Diodes

Sridharan¹,

Chirania²,

Towe³

et al. 2018

Micromachines

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“…After independent screening, 56 full-text articles were identified based on their respective titles and abstracts, and 13 articles were selected for data extraction based on the inclusion criteria. There were three RCTs, [25][26][27] six prospective noncomparative observational studies, [28][29][30][31][32][33] one retrospective noncomparative observation study, 34 and three case series. [35][36][37] Figure 1 shows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram of the study selection process.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…There were four studies that included PNS to the upper limbs, 28,34,36,37 two studies did not specifically indicate, 29,31 and the remaining included studies involved the lower limbs only. Leads were surgically placed in nine studies, [28][29][30][31][33][34][35][36][37] and placed under ultrasound guidance in the remaining studies. [25][26][27]32 One study used high frequency stimulation (5-10 kHz), 33 two studies used TIMEs, 35,36 one study used flat interface nerve electrodes, 37 and the remaining studies used more traditional PNS systems.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Leads were surgically placed in nine studies, [28][29][30][31][33][34][35][36][37] and placed under ultrasound guidance in the remaining studies. [25][26][27]32 One study used high frequency stimulation (5-10 kHz), 33 two studies used TIMEs, 35,36 one study used flat interface nerve electrodes, 37 and the remaining studies used more traditional PNS systems. Four studies included temporary leads, [25][26][27]32 and the remaining studies included permanently implanted leads.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Eight of the 13 included studies assessed pain intensity using different objective pain scales, all of which demonstrated clinically significant improvements. [25][26][27]30,32,33,35,36 Seven studies assessed PNS for PLP and found an overall percentage improvement in these scales ranging from 47% to 100%. [25][26][27]29,30,32,33,35,36 Similarly, six studies analyzed PNS for RLP and found improvements ranging from 50% to 100%.…”

Section: Primary Outcome-change In Pain Intensitymentioning

confidence: 99%

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Peripheral Nerve Stimulation for the Treatment of Post-Amputation Pain: A Systematic Review

Smith¹,

Twohey²,

Dean³

et al. 2023

Am J Phys Med Rehabil

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Despite numerous first-line treatment interventions, adequately managing a patient’s postamputation pain can be difficult. Peripheral nerve stimulation has emerged as a safe neuromodulatory intervention that can be used for many etiologies of chronic pain. We performed a systemic review to appraise the evidence of peripheral nerve stimulation use for improvement in postamputation pain. This was performed in Ovid, Cochrane databases, OVID, Scopus, Web of Science Core Collection, and PubMed. The primary outcome was improvement in postamputation pain after use of peripheral nerve stimulation. Secondary outcomes included improvements in functional status, opioid usage, and mood. Data extraction and risk of bias assessments were performed independently in a blinded manner. Of the 989 studies identified, 13 studies were included consisting of three randomized control trials, seven observational studies, and three case series. While large heterogeneity limited definitive conclusions, the included studies generally demonstrated favorable outcomes regarding pain reduction. Each included study that used an objective pain scale demonstrated clinically significant pain improvements. Per the Grading of Recommendations, Assessment, Development, and Evaluations criteria, there is very low-quality Grading of Recommendations, Assessment, Development, and Evaluations evidence supporting that peripheral nerve stimulation is associated with improvements in pain intensity for postamputation pain. Future prospective, comparative, and well-powered studies assessing the use of peripheral nerve stimulation for postamputation pain are warranted.

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High-frequency peripheral electric nerve block to treat postamputation pain

Cited by 2 publications

References 13 publications

Remote Stimulation of Sciatic Nerve Using Cuff Electrodes and Implanted Diodes

Remote Stimulation of Sciatic Nerve Using Cuff Electrodes and Implanted Diodes

Peripheral Nerve Stimulation for the Treatment of Post-Amputation Pain: A Systematic Review

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