The Appropriate Use of Neurostimulation: Stimulation of the Intracranial and Extracranial Space and Head for Chronic Pain

Deer, Timothy R.; Mekhail, Nagy; Petersen, Erika; Krames, Elliot S.; Staats, Peter S.; Pope, Jason E.; Saweris, Youssef; Lad, Shivanand P.; Diwan, Sudhir; Falowski, Steven; Feler, Claudio A.; Slavin, Konstantin V.; Narouze, Samer; Merabet, Lotfi B.; Buvanendran, Asokumar; Fregni, Felipe; Wellington, Joshua; Levy, Robert M.

doi:10.1111/ner.12215

Cited by 68 publications

(47 citation statements)

References 182 publications

(257 reference statements)

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“…15 In the following decades, the efficacy of neurostimulation was demonstrated in the management of chronic pain states with the use of surgically implanted spinal cord and peripheral nerve stimulators. 16,17 However, the application of neurostimulation to postoperative pain states has been limited by the invasive nature of the available electrical leads: conventional units typically require multiple electrodes in close proximity to the peripheral nerve that require invasive and time-consuming surgery to place. 18 In addition, these procedures require surgical reversal with removal of the leads, frequently complicated due to fibrous capsule formation adherent to the target nerve.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for Postoperative Analgesia

Grant

2016

Regional Anesthesia and Pain Medicine

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Section: Mechanism Of Actionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for Postoperative Analgesia

Grant

2016

Regional Anesthesia and Pain Medicine

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“…Subsequently, off-label use of commercially available stimulators was described to deliver nerve stimulation to peripheral nerves [10]. In the past 40 years, surgically implanted peripheral nerve and spinal cord stimulators have been validated and thoroughly investigated in managing chronic pain [11, 12]. …”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided percutaneous peripheral nerve stimulation for analgesia following total knee arthroplasty: a prospective feasibility study

et al. 2017

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BackgroundPeripheral nerve stimulation has been used for decades to treat chronic pain but has not been used for postoperative analgesia due to multiple limitations, beginning with invasive electrode placement. With the development of small-diameter/gauge leads enabling percutaneous insertion, ultrasound guidance for accurate introduction, and stimulators small enough to be adhered to the skin, neurostimulation may now be provided in a similar manner to continuous peripheral nerve blocks. Here, we report on the use of ultrasound-guided percutaneous peripheral nerve stimulation to treat postoperative pain.Materials and methodsSubjects within 60 days of a total knee arthroplasty with pain insufficiently treated with oral analgesics had a 0.2-mm-diameter electrical lead (pre-loaded into a 20 gauge needle) introduced percutaneously using ultrasound guidance with the tip located approximately 0.5–1.0 cm from the femoral nerve (a second lead was inserted approximately 1.0–3.0 cm from the sciatic nerve for posterior knee pain). An external stimulator delivered current. Endpoints were assessed before and after lead insertion and the leads subsequently removed. Due to the small sample size for this pilot/feasibility study, no statistics were applied to the data.ResultsLeads were inserted in subjects (n = 5) 8–58 days postoperatively. Percutaneous peripheral nerve stimulation decreased pain an average of 93% at rest (from a mean of 5.0 to 0.2 on a 0–10 numeric rating scale), with 4 of 5 subjects experiencing complete resolution of pain. During passive and active knee motion pain decreased an average of 27 and 30%, respectively. Neither maximum passive nor active knee range-of-motion was consistently affected.ConclusionsUltrasound-guided percutaneous peripheral nerve stimulation may be a practical modality for the treatment of postoperative pain following orthopedic surgical procedures, and further investigation appears warranted.

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“…Electrodes are also placed on peripheral nerves in the head and neck to modulate headaches. A novel approach approved in Europe and Australia stimulates the vagus nerve noninvasively as a prophylaxis and treatment for cluster headaches and migraines [21].…”

Section: Spinal Cord Stimulationmentioning

confidence: 99%

Alternatives to Opiates in the Management of Non-cancer-related Pain

Staats

Silverman

2016

Controlled Substance Management in Chronic Pain

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The Appropriate Use of Neurostimulation: Stimulation of the Intracranial and Extracranial Space and Head for Chronic Pain

Cited by 68 publications

References 182 publications

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for Postoperative Analgesia

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for Postoperative Analgesia

Ultrasound-guided percutaneous peripheral nerve stimulation for analgesia following total knee arthroplasty: a prospective feasibility study

Alternatives to Opiates in the Management of Non-cancer-related Pain

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