China
Africa
Explore chapters and articles related to this topic
Neurostimulation techniques
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Peripheral nerve field stimulation is a relatively new concept, wherein spinal stimulation cylindrical leads are introduced percutaneously into the subcutaneous tissues in the area of pain to stimulate small afferents which may not be as amenable to single peripheral nerve stimulation placement by open technique.
High-frequency spinal cord stimulation at 10 kHz for widespread pain: a retrospective survey of outcomes from combined cervical and thoracic electrode placements
Published in Postgraduate Medicine, 2019
Of the 45 patients that underwent a semi-permanent trial, 38 reported a successful outcome and proceeded to an IPG implant, resulting in a trial to implant conversion rate of 84.4%. Ten of these patients had previously failed traditional SCS and/or peripheral nerve field stimulation (28.6%). Patients implanted with an IPG were followed up at a mean of 2.3 ± 1.7 years post-implant (minimum of 6 months post-implant), at which point 35/38 (92.1%) patients were still using their HF10-SCS for managing their pain. The three patients not using their HF10-SCS system at follow up were not included in the following analysis and gave the following explanations: severe spinal stenosis (n = 1), electrode dysfunction (high impedance) (n = 1) and opting to try alternative therapies (n = 1).
Spinal cord stimulation in the treatment of peripheral vascular disease: a systematic review – revival of a promising therapeutic option?
Published in British Journal of Neurosurgery, 2022
Evridiki Asimakidou, Georgios K. Matis
A relevant application of SCS in patients with CLI who undergo amputation is the treatment of phantom limb pain (PLP), a condition that occurs in 50–80% of amputees.50 The majority of studies investigating the efficacy of SCS for PLP were small-scale uncontrolled clinical trials with less than 10 patients in their study population and controversial results.51–54 In 2010, Viswanathan et al.55 performed a review of previous case series of PLP patients treated with SCS. Overall, the authors concluded, that SCS is a low-risk intervention, that can offer pain relief and improvement of functional status to patients with PLP. In a more recent systematic review, Aiyer et al.56 reported, that seven of the 12 included studies demonstrated clinically significant results for pain relief in PLP patients after SCS. In the earlier case series published before 1980 the electrode implantation was subdural or endodural but thereafter the epidural placement became more common. Interestingly, Eldabe et al.57 utilised DRG stimulation to treat eight PLP patients with a mean follow-up of 9 months. Five patients achieved good pain relief, in one of them pain relief was complete, whereas three of the eight patients had a poor outcome. The authors concluded, that DRG stimulation might be effective for patients with PLP. DRG is a novel target for SCS instead of the dorsal columns. The main advantage of DRG stimulation is dermatomal specificity and hence a more precise paresthesia coverage.58 It has recently been reported, that DRG stimulation can also be conducted in a paresthesia- independent mode by programming the system to operate at subthreshold amplitudes.59 The study by Eldabe et al.57 was a pilot study, which provided positive preliminary results but further studies are warranted. Additionally, Gilmore et al.60 reported, that the application of percutaneous PNS in 28 amputees with residual limb pain (RLP) and/or PLP led to significant pain relief and functional improvement at the 12-month follow-up. Percutaneous PNS is a novel less-invasive approach that offers pain relief without the need for surgery and the accompanying complications.61 Both percutaneous PNS and peripheral nerve field stimulation (PNFS), where the electrodes are placed subcutaneously in the painful area stimulating the cutaneous afferents without direct contact with the peripheral nerve, have contributed to the broader use of PNS in chronic pain management over the past two decades.62 It is worth being investigated, if DRG stimulation and PNS could be useful for a subset of CLI-patients during the pre-amputation period, in view of the encouraging results obtained from patients with CRPS‐I, causalgia, postoperative pain, chronic low back pain, and the clinically relevant PLP.57,61,63–68