Peripheral trigeminal nerve field stimulation

Feletti, Alberto; Santi, Giannantonio Zanata; Sammartino, Francesco; Bevilacqua, Marzio; Cisotto, P.; Longatti, Pierluigi

doi:10.3171/2013.7.focus13228

Cited by 38 publications

(20 citation statements)

References 30 publications

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“…The third patient had a pain reduction from 10/10 to 4/10, but required re-siting of the lead due to migration. Feletti (5) reported a series of six cases with an average VAS reduction of 73%. Two of six patients reported reduced analgesic use.…”

Section: Discussionmentioning

confidence: 99%

“…Where all these measures are ineffective, or where medication causes intolerable side-effects, neuromodulation may be an option. Stimulation has been applied at a range of sites, including peripherally using subcutaneous electrodes in the face (2)(3)(4)(5)(6)(7)(8)(9), at the Gasserian ganglion (10)(11)(12), and centrally with high cervical spinal cord stimulation (targeting the spinal trigeminal nucleus) (13)(14)(15), deep brain stimulation (16) (targeting the ventroposteromedial nucleus of the thalamus and/or the periaqueductal gray matter), or motor cortex stimulation (17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

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Burst or Conventional Peripheral Nerve Field Stimulation for Treatment of Neuropathic Facial Pain

Manning

Ortega

Moir

et al. 2019

Neuromodulation: Technology at the Neural Interface

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Background Trigeminal Neuropathic Pain (TNP) is a chronic facial pain syndrome caused by a lesion or disease affecting one or more branches of the trigeminal nerve. It may, for example, result from accidental injury to a branch of the trigeminal nerve by trauma or during surgery; it may also be idiopathic. TNP is typically constant, in contrast to most cases of the commoner trigeminal neuralgia. In some cases, pain may be refractory to pharmacological treatment. Peripheral nerve field stimulation is recognized as an effective minimally invasive surgical treatment option for this debilitating condition. To date, stimulation has used conventional tonic waveforms, which generate paraesthesia in the stimulated area. This is the first report of the use of paraesthesia‐free burst pattern stimulation for TNP. Methods Seven patients were treated at the John Radcliffe Hospital for TNP from 2016 to 2018. Mean duration of preoperative symptoms was five years. All patients had exhausted pharmacological measures to limited effect. The initial three patients had tonic stimulation with the subsequent four having burst stimulation. Outcome was assessed using the numeric pain rating scale preoperatively and postoperatively at three and six months and one year. Side‐effects and complications were also assessed as well as reduction in analgesic medication use. Results All patients achieved pain reduction of at least 50% at 6 months (range 50–100%, mean 81%, p = 0.0082). Those in the burst stimulation group were paraesthesia free. One patient developed a postoperative infection for which the system had to be removed and is awaiting reimplantation. There were no other complications in either group. Conclusion Burst stimulation conferred similar pain control to tonic stimulation in our small cohort, and there were similar reductions in pain medication use. An additional benefit of burst stimulation is freedom from paraesthesia. Larger scale studies are needed to further evaluate burst stimulation and compare its efficacy with that of tonic stimulation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Burst or Conventional Peripheral Nerve Field Stimulation for Treatment of Neuropathic Facial Pain

Manning

Ortega

Moir

et al. 2019

Neuromodulation: Technology at the Neural Interface

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“…PNS has been shown to be efficacious in several chronic pain conditions including trigeminal neuropathic pain [ 12 – 16 ], episodic cluster headache (supraorbital nerve stimulation) [ 17 , 18 ], chronic migraine/headache disorders (occipital nerve stimulation) [ 19 , 20 ], fibromyalgia (C2 area stimulation) [ 21 , 22 ], postherpetic neuralgia [ 23 – 26 ], complex regional pain syndrome type I [ 4 , 27 ] and type II [ 28 ], isolated peripheral neuropathy [ 29 ], ilioinguinal, iliohypogastric, and lateral femoral cutaneous neuralgia [ 30 ], back pain [ 31 ], foot pain (tibial nerve stimulation) [ 32 ], and coccydynia [ 21 , 33 ].…”

Section: Indications and Patient Selectionmentioning

confidence: 99%

“…Most commonly, the electrode is placed through a 14G Tuoy needle in close proximity to the target nerve. Feletti and colleagues used small 3 mm incisions in the supra-auricular or preauricular area to access V2 and V3 divisions of the trigeminal nerve [ 12 ]. They observed better pain relief when electrodes were placed at the area of hyperalgesia compared with allodynia along the distribution of the trigeminal nerve.…”

Section: Implantation Processmentioning

confidence: 99%

Current Innovations in Peripheral Nerve Stimulation

Nayak

Banik

2018

Pain Research and Treatment

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Peripheral nerve stimulation has been used in the treatment of several chronic pain conditions including pain due to peripheral nerve dysfunctions, complex regional pain syndrome, and cranial neuralgias. It has been shown to be effective for chronic, intractable pain that is refractory to conventional therapies such as physical therapy, medications, transcutaneous electrical stimulations, and nerve blocks. Recently, a new generation of peripheral nerve stimulation devices has been developed; these allow external pulse generators to transmit impulses wirelessly to the implanted electrode, and their implantation is significantly less invasive. In this review, we discuss the history, pathophysiology, indications, implantation process, and outcomes of employing peripheral nerve stimulation to treat chronic pain conditions.

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“…As with all neuromodulatory approaches, trigeminal peripheral neurostimulation (PNS) offers the advantages of low surgical risk, nondestructiveness, reversibility, adjustability, and the theoretical possibility of long‐term alteration of central pain generators . After the first description of trigeminal PNS by Wall and Sweet in 1967, and in parallel with the success of occipital nerve stimulation for the treatment of occipital neuralgia , several retrospective case series focusing on trigeminal pain have been reported, totaling 59 patients (Table ) . In these studies, the efficacy of PNS ranges from 50 to 100% of patients reporting greater than 50% pain reduction, with average follow‐up of 21.4 months.…”

Section: Introductionmentioning

confidence: 99%