Peripheral Neuromodulation: A Review

Abstract

Peripheral nerve stimulation (PNS) is likely the most diverse and rapidly expanding area of neuromodulation. Its expansion has become possible due to both technological and clinical advances in pain medicine. The first implantable systems were surgically placed. However, it is currently commonplace to use percutaneous leads, as this approach has become instrumental in its expansion. The first percutaneous peripheral nerve stimulators were reported in 1999. Cylindrical leads were implanted to stimulate the greater occipital nerve to manage intractable headache. It has been expanded into other individual nerves or nerve plexuses to treat neuropathic, visceral, cardiac, abdominal, low back and facial pain. The use of PNS in modulating organ function in treatment of syndromes such as epilepsy, incontinence and obesity with vagal, tibial and gastric stimulation is under extensive investigation. New technologies that allow easier and safer electrode placement are expected to further expand the uses of PNS. A noninvasive stimulation will open this treatment modality to more clinicians of varying backgrounds.

Migraine Prevention Using Different Frequencies of Transcutaneous Occipital Nerve Stimulation: A Randomized Controlled Trial

“…6 Moreover, high-frequency TENS affects the δ-opioid receptor and increases the levels of β-endorphins in the bloodstream and enkephalin in the cerebrospinal fluid. 10,27 With the possible exception of endogenous opiate release, the 'gate control theory' is in fact the most M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 14 tenable view. 2,12,16,21 This was advanced in 1965 by Melzack and Wall, who found that activation of non-noxious afferent Aβ fibers may inhibit the Aδ and C fibers that mediate nociceptive transmission.…”

“…However, no randomized controlled trial has yet been performed. 10,27 Hence, the principal aim of this study was to evaluate the efficacy and tolerability of tONS (compared with TPM) in migraine patients and to explore whether different tONS frequencies influenced treatment effectiveness.…”

Neuralgia associated with transcutaneous electrical nerve stimulation therapy in a patient initially diagnosed with temporomandibular disorder

“…The onset of neuralgia symptoms may have been purely coincidental, but a possible explanation for the patient's neuralgia is perineural invasion of the ACC affecting the V 1 and V 2 branches of the trigeminal nerve, with these nerve branches stimulated by application of the TENS unit resulting in the patient's new symptoms. Typically, direct electrical stimulation of peripheral nerves causes decreased excitability, resulting in pain reduction, 17 and the authors speculate that the patient had a paradoxical response to the TENS therapy. The patient's complaint of persistent right otalgia, which had been previously evaluated by multiple health care Fig.…”

Recent advances in understanding and managing cancer pain

“…Neuromodulation is a diverse and rapidly expanding field of medicine that may prove to be revolutionary in the treatment of neuropathic CP 64, 65 . The modern era of neuromodulation in CP relief began in 1967 when Gol reported that repeated intracranial stimulation of the septal area resulted in effective pain control in several patients with cancer 66 .…”