Peripheral Nerve Stimulation for Fibromyalgia

Abstract

Fibromyalgia is a condition marked by widespread chronic pain, accompanied by a variety of other symptoms, including sleep and fatigue disorders, headaches, disorders of the autonomic nervous system, as well as cognitive and psychiatric symptoms. It occurs predominantly in women and is often associated with other systemic or autoimmune diseases. Despite its serious socio economical burden, the treatment options remain poor. In this chapter, the authors discuss the possibilities of using greater occipital nerve stimulation as a treatment for fibromyalgia, based on available clinical studies. Greater occipital nerve stimulation has already been used successfully to treat occipital neuralgia and various primary headache syndromes. Testable hypothetical working mechanisms are proposed to explain the surprising effect of this treatment on widespread bodily pain.

C2 Subcutaneous Stimulation for Failed Back Surgery Syndrome: A Case Report

“…C1‐C3 spinothalamic tract neurons process sensory information from widespread regions of the body . Upper SCS at C1‐C3 modifies firing rate of >90% of lumbosacral spinothalamic cells , and may therefore modulate transmission of noxious stimuli from lumbosacral origin, analogous to what has been proposed for the modulation of widespread bodily pain in fibromyalgia .…”

Occipital Nerve Field Transcranial Direct Current Stimulation Normalizes Imbalance Between Pain Detecting and Pain Inhibitory Pathways in Fibromyalgia

“…Occipital nerve field stimulation with subcutaneously implanted electrodes is used to treat primary headache syndromes [1], more generalized pain such as fibromyalgia [2,3], and even failed back surgery syndrome [4]. Transcranial direct current stimulation (tDCS) can predict the efficacy of implanted electrodes [5], suggesting that both techniques might exert a similar effect on pain processing in the brain.…”

C2 Nerve Field Stimulation for the Treatment of Fibromyalgia: A Prospective, Double-blind, Randomized, Controlled Cross-over Study

“…It delivers electrical pulses in the area supplied by the greater occipital nerves, which arise from the second cervical nerve complex, and is described as nerve field stimulation [20]. The mechanism of action is uncertain, but supposed to be due to the connections at the trigeminalecervical complex, a connection between the greater occipital nerve and brainstem structures including the nuclei of the trigeminal nerve and autonomic nervous system [14,21]. Subcutaneous nerve field stimulation of the area supplied by the greater occipital (C2) nerve modulates brain activity in several important regions involved in pain perception as shown by functional imaging including fMRI and PET techniques [22e24].…”