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Weiner RL, Garcia CM, Vanquathem N. A novel miniature, wireless neurostimulator in the management of chronic craniofacial pain: Preliminary results from a prospective pilot study. Scand J Pain 2017; 17:350-354. [PMID: 29030173 DOI: 10.1016/j.sjpain.2017.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To report a novel wireless neuromodulation system for treatment of refractory craniofacial pain. BACKGROUND Previous studies utilizing peripheral nerve stimulation (PNS) of the occipital and trigeminal nerves reported positive outcomes for alleviating neuropathic pain localized to the craniofacial and occipital areas. However several technological limitations and cosmetic concerns inhibited a more widespread acceptance and use of neuromodulation. Also, a relatively high incidence of adverse events like electrode erosions, dislocation, wire fracture and/or infection at the surgical site mandates a change in our approach to neuromodulation technology and implant techniques in the craniofacial region. METHODS We report a novel approach for the management of craniofacial pain with a wirelessly powered, minimally invasive PNS system. The system is percutaneously implanted and placed subcutaneously adjacent to affected facial nerves via visual guidance by the clinician. In this feasibility study, pilot evidence was gathered in a cohort of ten subjects suffering from a combination of chronic headaches, facial pain for at least 15 days per month and for at least 4h/day. RESULTS At four weeks post-implant follow up, all patients reported sustained pain relief of the primary pain area. Electrode location and total number of electrodes used per subject varied across the cohort. The average pain reduction using the visual analog scale was ≥82%. The procedure had no adverse events or side effects. CONCLUSION Percutaneous placement of a wireless neurostimulation device directly adjacent to affected craniofacial nerve(s) is a minimally invasive and reversible method of pain control in patients with craniofacial pain refractory to conventional medical managements. Preliminary results are encouraging and further larger scale studies are required for improved applications.
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Affiliation(s)
- Richard L Weiner
- Dallas Neurosurgical and Spine Associates, University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Niek Vanquathem
- StimRelieve LLC., 1310 Park Central Boulevard South, Pompano Beach, FL 33064, USA.
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Sokal P, Harat M, Zieliński P, Kierońska S. Tibial nerve stimulation with a miniature, wireless stimulator in chronic peripheral neuropathic pain. J Pain Res 2017; 10:613-619. [PMID: 28352201 PMCID: PMC5359134 DOI: 10.2147/jpr.s128861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peripheral neuropathic pain (PNP) and complex regional pain syndrome (CRPS) can be effectively treated with peripheral nerve stimulation. In this clinical trial report, effectiveness of novel, miniature, wirelessly controlled microstimulator of tibial nerve in PNP and CRPS was evaluated. In this pilot study the average preoperative visual analog scale (VAS) score in six patients was 7.5, with 1, 3 and 6 months: 2.6 (p=0.03), 1.6 (p=0.03), and 1.3 (p=0.02), respectively. The mean average score in the six patients a week preceding the baseline visit was 7.96, preceding the 1, 3 and 6 month visits: 3.32 (p=0.043), 3.65 (p=0.045), and 2.49 (p=0.002), respectively. The average short-form McGill pain score before surgery was 23.8, and after 1, 3 and 6 months it was 11.0 (p=0.45), 6.3 (p=0.043), and 4.5 (p=0.01), respectively. Applied therapy caused a reduction of pain immediately after its application and clinical improvement was sustained on a similar level in all patients for six months. No complications of the treatment were observed. Intermittent tibial nerve stimulation by using a novel, miniature, wirelessly controlled device can be effective and feasible in PNP and CRPS. It is a safe, minimally invasive, and convenient neuromodulative method.
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Affiliation(s)
- Paweł Sokal
- Department of Neurosurgery, Military Research Hospital, Bydgoszcz
| | - Marek Harat
- Department of Public Health, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń
| | - Piotr Zieliński
- Department of Sports Medicine, University of Physical Education and Sport, Gdansk, Poland
| | - Sara Kierońska
- Department of Neurosurgery, Military Research Hospital, Bydgoszcz
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Ilfeld BM, Gilmore CA, Grant SA, Bolognesi MP, Del Gaizo DJ, Wongsarnpigoon A, Boggs JW. Ultrasound-guided percutaneous peripheral nerve stimulation for analgesia following total knee arthroplasty: a prospective feasibility study. J Orthop Surg Res 2017; 12:4. [PMID: 28086940 PMCID: PMC5234248 DOI: 10.1186/s13018-016-0506-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral 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 methods Subjects 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. Results Leads 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. Conclusions Ultrasound-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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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, 200 West Arbor Drive, MC 8770, San Diego, CA, 92103-8770, USA.
| | - Christopher A Gilmore
- Department of Anesthesiology, Wake Forest University Baptist Medical Center, 145 Kimel Park Drive, Ste 330, Winston-Salem, NC, 27103, USA.,The Center for Clinical Research, Winston-Salem, NC, USA.,Carolinas Pain Institute, Winston-Salem, NC, USA
| | - Stuart A Grant
- Department of Anesthesiology, Duke University Medical Center, DUMC 3094, Durham, NC, 27710, USA
| | - Michael P Bolognesi
- Department of Orthopedic Surgery, Duke University Medical Center, 200 Trent Dr. #5216, Durham, NC, 27710, USA
| | - Daniel J Del Gaizo
- Department of Orthopedic Surgery, University of North Carolina, 3147 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27599-7055, USA
| | - Amorn Wongsarnpigoon
- SPR Therapeutics, LLC, 22901 Millcreek Blvd, Suite 110, Cleveland, OH, 44122, USA
| | - Joseph W Boggs
- SPR Therapeutics, LLC, 22901 Millcreek Blvd, Suite 110, Cleveland, OH, 44122, USA
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Ilfeld BM, Grant SA, Gilmore CA, Chae J, Wilson RD, Wongsarnpigoon A, Boggs JW. Neurostimulation for Postsurgical Analgesia: A Novel System Enabling Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation. Pain Pract 2016; 17:892-901. [PMID: 27910257 PMCID: PMC5637916 DOI: 10.1111/papr.12539] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/25/2016] [Accepted: 10/16/2016] [Indexed: 12/21/2022]
Abstract
While neurostimulation—stimulation of the nervous system using electrical current—has been used to treat chronic pain, its use treating postsurgical pain has been limited. Here, we report on the clinical application of a novel investigational lead to provide analgesia following total knee arthroplasty. In 5 subjects, leads were inserted percutaneously using ultrasound guidance within 0.5 to 3.0 cm of the femoral and/or sciatic nerve(s). With the delivery of current, pain decreased an average of 63% at rest, with 4 of 5 subjects having relief of > 50%. During passive and active knee flexion, pain decreased an average of 14% and 50%, with 0/3 and 1/2 subjects attaining > 50% relief, respectively. Ultrasound‐guided percutaneous peripheral nerve stimulation may be a practical modality for the treatment of postsurgical pain.
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Affiliation(s)
- Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, San Diego, California, U.S.A
| | - Stuart A Grant
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Christopher A Gilmore
- Department of Anesthesiology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A.,The Center for Clinical Research, Winston-Salem, North Carolina, U.S.A.,Carolinas Pain Institute, Winston-Salem, North Carolina, U.S.A
| | - John Chae
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, U.S.A.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, U.S.A.,MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, Ohio, U.S.A.,Cleveland Functional Electrical Stimulation Center, Cleveland, Ohio, U.S.A
| | - Richard D Wilson
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, U.S.A.,MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, Ohio, U.S.A.,Cleveland Functional Electrical Stimulation Center, Cleveland, Ohio, U.S.A
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Mammis A, Mogilner AY. A technique of distal to proximal revision of peripheral neurostimulator leads: technical note. Stereotact Funct Neurosurg 2011; 89:65-9. [PMID: 21293164 DOI: 10.1159/000323339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 12/02/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral nerve stimulation for chronic pain states is a safe and efficacious technique, being used with increasing frequency. The incidence of hardware-related complications requiring revision remains high. OBJECTIVES The authors describe a technique of distal to proximal neurostimulator lead revision, which does not require the changing of generators or extension leads, and thus presumably will minimize further device-related complications. METHODS The authors present a case series of 3 patients where the distal to proximal neurostimulator lead revision technique was utilized. RESULTS The technique was well tolerated in each instance and all patients reported >50% pain reduction at long-term follow-up. CONCLUSIONS The distal to proximal neurostimulator lead revision technique quickly and safely adjusts lead position, including both lead depth and lead tip location, without a need for replacement of components or revision of the entire system.
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Affiliation(s)
- Antonios Mammis
- Department of Neurosurgery, Cushing Neurosciences Institutes, Hofstra University School of Medicine and North Shore University Hospital, Manhasset, NY, USA
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Stuart RM, Winfree CJ. Neurostimulation Techniques for Painful Peripheral Nerve Disorders. Neurosurg Clin N Am 2009; 20:111-20, vii-viii. [DOI: 10.1016/j.nec.2008.07.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Peripheral nerve stimulation (PNS) has been used for treatment of neuropathic pain for more than 40 years. Recent resurgence of interest to this elegant surgical modality came from the introduction of less invasive implantation techniques and the wider acceptance of neuromodulation as a treatment of medically refractory cases. This article reviews the literature on the use of PNS for neuropathic pain and describes current indications and hardware choices in frequent use. Published experience indicates that neuropathic pain responds to PNS in many patients. PNS works well in both established indications, such as post-traumatic and postsurgical neuropathy, occipital neuralgia, and complex regional pain syndromes, and in relatively new indications for neuromodulation, such as migraines and daily headaches, cluster headaches, and fibromyalgia. Future research and growing clinical experience will help in identifying the best candidates for PNS, choosing the best procedure and best hardware for each individual patient, and defining adequate expectations for patients and pain specialists.
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Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
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