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Dorrian RM, Leonard AV, Lauto A. Millimetric devices for nerve stimulation: a promising path towards miniaturization. Neural Regen Res 2024; 19:1702-1706. [PMID: 38103235 PMCID: PMC10960286 DOI: 10.4103/1673-5374.389627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/21/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023] Open
Abstract
Nerve stimulation is a rapidly developing field, demonstrating positive outcomes across several conditions. Despite potential benefits, current nerve stimulation devices are large, complicated, and are powered via implanted pulse generators. These factors necessitate invasive surgical implantation and limit potential applications. Reducing nerve stimulation devices to millimetric sizes would make these interventions less invasive and facilitate broader therapeutic applications. However, device miniaturization presents a serious engineering challenge. This review presents significant advancements from several groups that have overcome this challenge and developed millimetric-sized nerve stimulation devices. These are based on antennas, mini-coils, magneto-electric and opto-electronic materials, or receive ultrasound power. We highlight key design elements, findings from pilot studies, and present several considerations for future applications of these devices.
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Affiliation(s)
- Ryan M. Dorrian
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Anna V. Leonard
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Antonio Lauto
- School of Science, Western Sydney University, Penrith, NSW, Australia
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2
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Parikh S, Echevarria AC, Cemenski BR, Small T. The Relevance of Implanted Percutaneous Electrical Nerve Stimulation in Orthopedics Surgery: A Systematic Review. J Clin Med 2024; 13:3699. [PMID: 38999266 PMCID: PMC11242780 DOI: 10.3390/jcm13133699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/17/2024] [Accepted: 05/30/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Percutaneous peripheral nerve stimulation (PNS) is a form of neuromodulation that involves the transmission of electrical energy via metal contacts known as leads or electrodes. PNS has gained popularity in orthopedic surgery as several studies have supported its use as a pain control device for patients suffering from pain due to orthopedic pathologies involving the knee, shoulder, and foot. The purpose of this systematic review is to summarize the literature involving peripheral nerve stimulation in orthopedic surgery. The existing body of literature provides support for further research regarding the use of PNS in the management of knee pain, hip pain, shoulder pain, foot pain, and orthopedic trauma. Notably, the evidence for its efficacy in addressing knee and shoulder pain is present. Methods: This study was conducted following PRISMA guidelines. Seven hundred and forty-five unique entries were identified. Two blinded reviewers assessed each article by title and abstract to determine its relevance and categorized them as "include", "exclude", and "maybe". After a preliminary review was completed, reviewers were unblinded and a third reviewer retrieved articles labeled as "maybe" and those with conflicting labels to determine their relevance. Twenty-eight articles were included, and seven hundred and seventeen articles were excluded. Articles discussing the use of PNS in the field of orthopedic surgery in patients > 18 years of age after 2010 were included. Exclusion criteria included neuropathic pain, phantom limb pain, amputation, non-musculoskeletal related pathology, non-orthopedic surgery related pathology, spinal cord stimulator, no reported outcomes, review articles, abstracts only, non-human subjects. Results: A total of 16 studies analyzing 69 patients were included. All studies were either case series or case reports. Most articles involved the application of PNS in the knee (8) and shoulder (6) joint. Few articles discussed its application in the foot and orthopedic trauma. All studies demonstrated that PNS was effective in reducing pain. Discussion: Peripheral nerve stimulation can be effective in managing postoperative or chronic pain in patients suffering from orthopedic pathology. This systematic review is limited by the scarcity of robust studies with substantial sample sizes and extended follow up periods in the existing literature.
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Affiliation(s)
- Sarthak Parikh
- Saint Francis Health Systems, Tulsa, OK 74136, USA
- Department of Orthopedic Surgery, Oklahoma State University, Tulsa, OK 74078, USA
- Orthopedic and Trauma Services of Oklahoma, Tulsa, OK 74135, USA
| | - Alexandra C Echevarria
- Kiran Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL 33328, USA
| | - Brandon R Cemenski
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA 50266, USA
| | - Travis Small
- Saint Francis Health Systems, Tulsa, OK 74136, USA
- Department of Orthopedic Surgery, Oklahoma State University, Tulsa, OK 74078, USA
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3
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Ruan QZ, Chang J, Pak D, Supra R, Yazdi C, Kollenburg L, Kurt E, Reece D, Fonseca ACG, Abd-Elsayed A, Robinson CL. Literature Review: Mechanism, Indications, and Clinical Efficacy of Peripheral Nerve Stimulators in Lower Extremity Pain. Curr Pain Headache Rep 2024; 28:469-479. [PMID: 38512600 DOI: 10.1007/s11916-024-01240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW Lower extremity pain is deemed by Center for Disease Control and Prevention (CDC) to be a significant source of chronic pain in adults. If not appropriately managed, patients are subjected to risks of prolonged musculoskeletal dysfunction, disruption to quality of life, and elevated healthcare expenditures. Peripheral nerve stimulation (PNS) has shown great potential in recent years demonstrating efficacy in multiple diagnoses ranging from acute post-surgical pain to complex regional pain syndrome (CRPS). This study seeks to delineate efficacy of peripheral neuromodulation in the context of chronic lower extremity pain. RECENT FINDINGS Prevailing clinical studies demonstrate evidence levels ranging from II to V (Oxford Centre of Level of Evidence) in lower limb PNS, attaining positive outcomes in pain scores, opioid use, and quality of life measures. Nerves most frequently targeted are the sciatic and femoral nerves with post-amputation pain and CRPS most commonly investigated for efficacy. PNS is a promising therapeutic modality demonstrated to be effective for a variety of nociceptive and neuropathic pain conditions in the lower extremity. PNS offers chronic pain physicians a powerful tool in the multi-modal management of lower limb chronic pain.
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Affiliation(s)
- Qing Zhao Ruan
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA.
| | - Jason Chang
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA
| | - Daniel Pak
- Department of Anesthesiology, Weill Cornell Medicine, 1300 York Ave, New York City, NY, 10021, USA
| | - Rajesh Supra
- Georgetown University School of Medicine, Washington, DC, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Linda Kollenburg
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Reece
- Absolute Pain Management, Rockville, MD, USA
| | - Alexandra C G Fonseca
- Harvard Medical School, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, MA, USA
| | - Alaa Abd-Elsayed
- Chronic Pain Medicine, Department of Anesthesiology, University of Wisconsin-Madison, Madison, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA, USA
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Pierson CJ, Velez N, Jain NB, Konda C. Changing Stimulation Frequency Improves Implanted Peripheral Nerve Stimulator Effects After Posttraumatic Total Hip Arthroplasty: A Case Report. Am J Phys Med Rehabil 2024; 103:e67-e70. [PMID: 38466169 DOI: 10.1097/phm.0000000000002411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT Total hip arthroplasty is an effective procedure to improve pain, range of motion, and function for a variety of conditions, including osteoarthritis and posttraumatic arthritis. Up to 28% of patients had persistent pain at the surgical site 12-18 mos after total hip arthroplasty, even in the absence of surgical complications. Currently, there are no widely accepted nonpharmacological treatments for persistent postoperative pain for total hip arthroplasty. This case report details the successful management of a 53-yr-old man with chronic pain and weakness after posttraumatic total hip arthroplasty. He was initially treated with a single-lead percutaneous peripheral nerve stimulator near the right femoral nerve for 4 weeks with 100-Hz frequency sensory-level parameters. Four weeks after implantation, the frequency was changed to 12 Hz with a goal of motor-level stimulation. During the after 3-week time period, his hip flexion strength improved from 10.36 kg to 23.04 kg. His Lower Extremity Functional Scale improved from 35/80 (43.75%) to 54/80 (67.5%) within a 5-wk time period. This case's success demonstrates how peripheral nerve stimulation may help improve postoperative persistent pain and weakness in many patients, including those with posttraumatic arthroplasty.
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Affiliation(s)
- Chris J Pierson
- From the Department of Applied Clinical Research, The University of Texas Southwestern Medical Center, Dallas, Texas (CJP); The University of Texas Southwestern Medical Center School of Medicine, Dallas, Texas (NV); and Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas (NBJ, CK)
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5
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Sander MY, Zhu X. Infrared neuromodulation-a review. REPORTS ON PROGRESS IN PHYSICS. PHYSICAL SOCIETY (GREAT BRITAIN) 2024; 87:066701. [PMID: 38701769 DOI: 10.1088/1361-6633/ad4729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 05/03/2024] [Indexed: 05/05/2024]
Abstract
Infrared (IR) neuromodulation (INM) is an emerging light-based neuromodulation approach that can reversibly control neuronal and muscular activities through the transient and localized deposition of pulsed IR light without requiring any chemical or genetic pre-treatment of the target cells. Though the efficacy and short-term safety of INM have been widely demonstrated in both peripheral and central nervous systems, the investigations of the detailed cellular and biological processes and the underlying biophysical mechanisms are still ongoing. In this review, we discuss the current research progress in the INM field with a focus on the more recently discovered IR nerve inhibition. Major biophysical mechanisms associated with IR nerve stimulation are summarized. As the INM effects are primarily attributed to the spatiotemporal thermal transients induced by water and tissue absorption of pulsed IR light, temperature monitoring techniques and simulation models adopted in INM studies are discussed. Potential translational applications, current limitations, and challenges of the field are elucidated to provide guidance for future INM research and advancement.
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Affiliation(s)
- Michelle Y Sander
- Department of Electrical and Computer Engineering, Boston University, 8 Saint Mary's Street, Boston, MA 02215, United States of America
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215, United States of America
- Division of Materials Science and Engineering, Boston University, 15 Saint Mary's Street, Brookline, MA 02446, United States of America
- Photonics Center, Boston University, 8 Saint Mary's Street, Boston, MA 02215, United States of America
- Neurophotonics Center, Boston University, 24 Cummington Mall, Boston, MA 02215, United States of America
| | - Xuedong Zhu
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA 02215, United States of America
- Photonics Center, Boston University, 8 Saint Mary's Street, Boston, MA 02215, United States of America
- Neurophotonics Center, Boston University, 24 Cummington Mall, Boston, MA 02215, United States of America
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6
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Yoon SH, Tabansi P, Javed S. Peripheral nerve stimulation for psoas muscle pain. Pain Manag 2024; 14:119-124. [PMID: 38440795 DOI: 10.2217/pmt-2023-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
The psoas muscle is the largest muscle in the lower lumbar spine and is innervated by the ipsilateral lumbar spinal nerve roots (L2-L4). Here, we present a 44-year-old female with left hip pain in the posterolateral aspect of the left hip radiating to the ipsilateral hamstring, and psoas atrophy (based on imaging). She is now reported to have over 50% improvement in pain scores after underdoing temporary peripheral nerve stimulation of the psoas muscle as well as significant improvement in muscle atrophy based on an electromyography (EMG) study. This case study is the first to report documented improvement in muscle atrophy based on EMG after peripheral nerve stimulation of the targeted area.
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Affiliation(s)
- Syn Hae Yoon
- Department of Anesthesiology & Pain Medicine, El-Hospital, Namyang-ju, 12122, South Korea
| | - Precious Tabansi
- Department of Pain medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Saba Javed
- Department of Pain medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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7
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Kalava A, Mihaylov SV, Austin HK, Acharya S. Peripheral Nerve Stimulation for a Refractory Case of Postherpetic Neuralgia in the Upper Limb: A Case Report. Cureus 2024; 16:e55168. [PMID: 38558725 PMCID: PMC10979704 DOI: 10.7759/cureus.55168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome that is a direct consequence of the reactivation of varicella zoster virus (VZV). It manifests as neuropathic pain, which is pain that occurs because of dysfunction or damage of the nerves that carry sensations to the brain, and this typically persists for months to years after herpes zoster. Current conservative management for PHN includes a combination of topical agents (i.e., lidocaine and capsaicin) and systemic therapy (i.e., serotonin and norepinephrine reuptake inhibitors (SNRIs), gabapentin, pregabalin, and opioids). For refractory cases, with persistent intractable pain, more invasive interventional techniques can be used as pain-relieving measures to improve the patient's quality of life. This report presents a patient with upper limb PHN who responded to peripheral nerve stimulation (PNS) after he failed to obtain sufficient pain relief with conservative management.
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Affiliation(s)
- Arun Kalava
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
| | | | - Harriet Kaye Austin
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
| | - Saru Acharya
- Anesthesia and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Karri J, Marathe A, Smith TJ, Wang EJ. The Use of Scrambler Therapy in Treating Chronic Pain Syndromes: A Systematic Review. Neuromodulation 2023; 26:1499-1509. [PMID: 35691908 DOI: 10.1016/j.neurom.2022.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Scrambler therapy (ST) is a noninvasive method of transcutaneous neuromodulation that has 510(K) clearance from the United States Food and Drug Administration for treating acute pain, postoperative pain, and intractable chronic pain. Since its inception, ST has been used to treat many chronic pain syndromes in a variety of patient populations. We synthesized the available literature for ST to delineate its overall evidence basis. MATERIALS AND METHODS We performed a systematic review based on conventional Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods by surveying multiple data sources from January 1950 through October 2021. Two review authors, independently and in a standardized, unblinded fashion, conducted a systematic review to identify relevant studies and extract the necessary outcome measures. A conservative search strategy was implemented to identify all ST studies for the treatment of chronic pain syndromes. Primary outcome parameters collected were analgesic benefit, adverse effects, and other metrics such as sensorimotor testing. RESULTS A total of 21 studies met the final criteria for study inclusion and comprised randomized controlled trials (n = 8), prospective observational studies (n = 10), and retrospective cohort studies (n = 3). Nearly all the reported studies explored the use of ST for the treatment of neuropathic pain, with chemotherapy-induced peripheral neuropathy being the most studied condition. Most studies were limited by small cohorts but reported ST being safe, well tolerated, and providing clinically meaningful pain reduction. The duration of posttreatment follow-up ranged from ten to 14 days (concordant with completion of typical ST protocols) to three months. Secondary benefits such as medication reduction and improvement of sensory and motor symptoms were noted by some studies. CONCLUSIONS ST is regarded as a safe intervention with potential for significant analgesic benefit for neuropathic pain conditions. Although the available evidence is most robust for treating chemotherapy-induced peripheral neuropathy, ST has also been shown to be effective in treating other neuropathic pain syndromes. Evidence for ST use in nociceptive pain conditions is limited but appears promising. The favorable safety profile and increasing evidence basis for ST warrant more extensive recognition and consideration for use in clinical care.
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Affiliation(s)
- Jay Karri
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Thomas J Smith
- Department of Internal Medicine, Division of General Medicine, and Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA; Department of Internal Medicine, Division of Palliative Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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9
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Abd-Elsayed A, Keith MK, Cao NN, Fiala KJ, Martens JM. Temporary Peripheral Nerve Stimulation as Treatment for Chronic Pain. Pain Ther 2023; 12:1415-1426. [PMID: 37737951 PMCID: PMC10616055 DOI: 10.1007/s40122-023-00557-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Chronic pain is a growing problem across the world, and in the midst of an opioid epidemic, it is imperative that alternative treatment measures are identified to help alleviate the pain experienced by these patients. Chronic pain greatly affects ones quality of life and many patients do not experience adequate relief with conventional treatment measures. The purpose of this retrospective analysis is to assess the efficacy of peripheral nerve stimulation (PNS) therapy in adult patients suffering from chronic pain refractory to conventional treatment measures who underwent therapy on various anatomical locations. METHODS This retrospective analysis consisted of data collected from electronic health records for n = 89 patients who underwent PNS therapy. Data collected relates to patient age, sex, weight, height, body mass index (BMI), diagnosis, targeted nerves, follow-up encounters, pain scores from before and after PNS therapy, and duration of improvement. Statistical analysis used SPSS software, version 26 (IBM), using a paired t test to assess significance between pre and post PNS therapy pain scores. P values were significant if found to be ≤ 0.05. Further analysis assessed the correlation between age and BMI with visual analog scale (VAS) pain improvement and subjective percentage pain relief. RESULTS The mean pre-operative (pre-op) pain score before PNS therapy was 6.36 (standard deviation (SD) = 2.18, SEM = 0.23) and the mean post-operative (post-op) pain score after PNS therapy was 4.19 (SD = 2.70, SEM = 0.29). The mean patient-reported percent improvement in pain following PNS therapy was 49.04% (SD = 34.79). The improvement in pain scores between pre-op and post-op was statistically significant (M = 2.17, SD = 2.82, SEM = 0.30, t(88) = 7.26, p < .001), 95% confidence interval (CI) [1.57, 2.76]. The mean duration of improvement for patients was 123 days after therapy initiation (min = 6, max = 683, SD = 126). CONCLUSIONS This study demonstrated the potential role for PNS therapy in improving patient-reported pain levels for various neuropathies, targeting various nerves. With PNS therapy's use as a chronic pain treatment and available research being limited, further study needs to be done on the efficacy of PNS therapy for pain management and complications associated with PNS device placements at various locations.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA.
| | - Mitchell K Keith
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - Nancy N Cao
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - Kenneth J Fiala
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - Joshua M Martens
- Department of Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
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10
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Choi D, Lee Y, Lin ZH, Cho S, Kim M, Ao CK, Soh S, Sohn C, Jeong CK, Lee J, Lee M, Lee S, Ryu J, Parashar P, Cho Y, Ahn J, Kim ID, Jiang F, Lee PS, Khandelwal G, Kim SJ, Kim HS, Song HC, Kim M, Nah J, Kim W, Menge HG, Park YT, Xu W, Hao J, Park H, Lee JH, Lee DM, Kim SW, Park JY, Zhang H, Zi Y, Guo R, Cheng J, Yang Z, Xie Y, Lee S, Chung J, Oh IK, Kim JS, Cheng T, Gao Q, Cheng G, Gu G, Shim M, Jung J, Yun C, Zhang C, Liu G, Chen Y, Kim S, Chen X, Hu J, Pu X, Guo ZH, Wang X, Chen J, Xiao X, Xie X, Jarin M, Zhang H, Lai YC, He T, Kim H, Park I, Ahn J, Huynh ND, Yang Y, Wang ZL, Baik JM, Choi D. Recent Advances in Triboelectric Nanogenerators: From Technological Progress to Commercial Applications. ACS NANO 2023; 17:11087-11219. [PMID: 37219021 PMCID: PMC10312207 DOI: 10.1021/acsnano.2c12458] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
Serious climate changes and energy-related environmental problems are currently critical issues in the world. In order to reduce carbon emissions and save our environment, renewable energy harvesting technologies will serve as a key solution in the near future. Among them, triboelectric nanogenerators (TENGs), which is one of the most promising mechanical energy harvesters by means of contact electrification phenomenon, are explosively developing due to abundant wasting mechanical energy sources and a number of superior advantages in a wide availability and selection of materials, relatively simple device configurations, and low-cost processing. Significant experimental and theoretical efforts have been achieved toward understanding fundamental behaviors and a wide range of demonstrations since its report in 2012. As a result, considerable technological advancement has been exhibited and it advances the timeline of achievement in the proposed roadmap. Now, the technology has reached the stage of prototype development with verification of performance beyond the lab scale environment toward its commercialization. In this review, distinguished authors in the world worked together to summarize the state of the art in theory, materials, devices, systems, circuits, and applications in TENG fields. The great research achievements of researchers in this field around the world over the past decade are expected to play a major role in coming to fruition of unexpectedly accelerated technological advances over the next decade.
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Affiliation(s)
- Dongwhi Choi
- Department
of Mechanical Engineering (Integrated Engineering Program), Kyung Hee University, Yongin, Gyeonggi 17104, South Korea
| | - Younghoon Lee
- Department
of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
- Department
of Mechanical Engineering, Soft Robotics Research Center, Seoul National University, Seoul 08826, South Korea
- Department
of Mechanical Engineering, Gachon University, Seongnam 13120, Korea
| | - Zong-Hong Lin
- Department
of Mechanical Engineering (Integrated Engineering Program), Kyung Hee University, Yongin, Gyeonggi 17104, South Korea
- Department
of Biomedical Engineering, National Taiwan
University, Taipei 10617, Taiwan
- Frontier
Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Sumin Cho
- Department
of Mechanical Engineering (Integrated Engineering Program), Kyung Hee University, Yongin, Gyeonggi 17104, South Korea
| | - Miso Kim
- School
of Advanced Materials Science & Engineering, Sungkyunkwan University, Suwon 16419, Republic
of Korea
- SKKU
Institute of Energy Science and Technology (SIEST), Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
| | - Chi Kit Ao
- Department
of Chemical and Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, 117585, Singapore
| | - Siowling Soh
- Department
of Chemical and Biomolecular Engineering, National University of Singapore, 4 Engineering Drive 4, 117585, Singapore
| | - Changwan Sohn
- Division
of Advanced Materials Engineering, Jeonbuk
National University, 567 Baekje-daero, Deokjin-gu, Jeonju, Jeonbuk 54896, South Korea
- Department
of Energy Storage/Conversion Engineering of Graduate School (BK21
FOUR), Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju, Jeonbuk 54896, South Korea
| | - Chang Kyu Jeong
- Division
of Advanced Materials Engineering, Jeonbuk
National University, 567 Baekje-daero, Deokjin-gu, Jeonju, Jeonbuk 54896, South Korea
- Department
of Energy Storage/Conversion Engineering of Graduate School (BK21
FOUR), Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju, Jeonbuk 54896, South Korea
| | - Jeongwan Lee
- Department
of Physics, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, South Korea
| | - Minbaek Lee
- Department
of Physics, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, South Korea
| | - Seungah Lee
- School
of Materials Science & Engineering, Yeungnam University, Gyeongsan, Gyeongbuk 38541, South Korea
| | - Jungho Ryu
- School
of Materials Science & Engineering, Yeungnam University, Gyeongsan, Gyeongbuk 38541, South Korea
| | - Parag Parashar
- Department
of Biomedical Engineering, National Taiwan
University, Taipei 10617, Taiwan
| | - Yujang Cho
- Department
of Materials Science and Engineering, Korea
Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro,
Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Jaewan Ahn
- Department
of Materials Science and Engineering, Korea
Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro,
Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Il-Doo Kim
- Department
of Materials Science and Engineering, Korea
Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro,
Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Feng Jiang
- School
of Materials Science and Engineering, Nanyang
Technological University, 50 Nanyang Avenue, 639798, Singapore
- Institute of Flexible
Electronics Technology of Tsinghua, Jiaxing, Zhejiang 314000, China
| | - Pooi See Lee
- School
of Materials Science and Engineering, Nanyang
Technological University, 50 Nanyang Avenue, 639798, Singapore
| | - Gaurav Khandelwal
- Nanomaterials
and System Lab, Major of Mechatronics Engineering, Faculty of Applied
Energy System, Jeju National University, Jeju 632-43, South Korea
- School
of Engineering, University of Glasgow, Glasgow G128QQ, U. K.
| | - Sang-Jae Kim
- Nanomaterials
and System Lab, Major of Mechatronics Engineering, Faculty of Applied
Energy System, Jeju National University, Jeju 632-43, South Korea
| | - Hyun Soo Kim
- Electronic
Materials Research Center, Korea Institute
of Science and Technology (KIST), Seoul 02792, Republic of Korea
- Department
of Physics, Inha University, Incheon 22212, Republic of Korea
| | - Hyun-Cheol Song
- Electronic
Materials Research Center, Korea Institute
of Science and Technology (KIST), Seoul 02792, Republic of Korea
- KIST-SKKU
Carbon-Neutral Research Center, Sungkyunkwan
University (SKKU), Suwon 16419, Republic
of Korea
| | - Minje Kim
- Department
of Electrical Engineering, College of Engineering, Chungnam National University, 34134, Daehak-ro, Yuseong-gu, Daejeon 34134, South Korea
| | - Junghyo Nah
- Department
of Electrical Engineering, College of Engineering, Chungnam National University, 34134, Daehak-ro, Yuseong-gu, Daejeon 34134, South Korea
| | - Wook Kim
- School
of Mechanical Engineering, College of Engineering, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
| | - Habtamu Gebeyehu Menge
- Department
of Mechanical Engineering, College of Engineering, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 17058, Republic of Korea
| | - Yong Tae Park
- Department
of Mechanical Engineering, College of Engineering, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin, Gyeonggi 17058, Republic of Korea
| | - Wei Xu
- Research
Centre for Humanoid Sensing, Zhejiang Lab, Hangzhou 311100, P. R. China
| | - Jianhua Hao
- Department
of Applied Physics, The Hong Kong Polytechnic
University, Hong Kong, P.R. China
| | - Hyosik Park
- Department
of Energy Science and Engineering, Daegu
Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea
| | - Ju-Hyuck Lee
- Department
of Energy Science and Engineering, Daegu
Gyeongbuk Institute of Science and Technology (DGIST), Daegu 42988, Republic of Korea
| | - Dong-Min Lee
- School
of Advanced Materials Science & Engineering, Sungkyunkwan University, Suwon 16419, Republic
of Korea
| | - Sang-Woo Kim
- School
of Advanced Materials Science & Engineering, Sungkyunkwan University, Suwon 16419, Republic
of Korea
- SKKU
Institute of Energy Science and Technology (SIEST), Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
- Samsung
Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 115, Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
- SKKU
Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
| | - Ji Young Park
- School
of Advanced Materials Science & Engineering, Sungkyunkwan University, Suwon 16419, Republic
of Korea
| | - Haixia Zhang
- National
Key Laboratory of Science and Technology on Micro/Nano Fabrication;
Beijing Advanced Innovation Center for Integrated Circuits, School
of Integrated Circuits, Peking University, Beijing 100871, China
| | - Yunlong Zi
- Thrust
of Sustainable Energy and Environment, The
Hong Kong University of Science and Technology (Guangzhou), Nansha, Guangdong 511400, China
| | - Ru Guo
- Thrust
of Sustainable Energy and Environment, The
Hong Kong University of Science and Technology (Guangzhou), Nansha, Guangdong 511400, China
| | - Jia Cheng
- State
Key Laboratory of Tribology in Advanced Equipment, Department of Mechanical
Engineering, Tsinghua University, Beijing 100084, China
| | - Ze Yang
- State
Key Laboratory of Tribology in Advanced Equipment, Department of Mechanical
Engineering, Tsinghua University, Beijing 100084, China
| | - Yannan Xie
- College
of Automation & Artificial Intelligence, State Key Laboratory
of Organic Electronics and Information Displays & Institute of
Advanced Materials, Jiangsu Key Laboratory for Biosensors, Jiangsu
National Synergetic Innovation Center for Advanced Materials, Nanjing University of Posts and Telecommunications, Nanjing, Jiangsu 210023, China
| | - Sangmin Lee
- School
of Mechanical Engineering, Chung-ang University, 84, Heukseok-ro, Dongjak-gu, Seoul 06974, South Korea
| | - Jihoon Chung
- Department
of Mechanical Design Engineering, Kumoh
National Institute of Technology (KIT), 61 Daehak-ro, Gumi, Gyeongbuk 39177, South Korea
| | - Il-Kwon Oh
- National
Creative Research Initiative for Functionally Antagonistic Nano-Engineering,
Department of Mechanical Engineering, School of Mechanical and Aerospace
Engineering, Korea Advanced Institute of
Science and Technology (KAIST), Daejeon 34141, South Korea
| | - Ji-Seok Kim
- National
Creative Research Initiative for Functionally Antagonistic Nano-Engineering,
Department of Mechanical Engineering, School of Mechanical and Aerospace
Engineering, Korea Advanced Institute of
Science and Technology (KAIST), Daejeon 34141, South Korea
| | - Tinghai Cheng
- Beijing
Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
| | - Qi Gao
- Beijing
Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
| | - Gang Cheng
- Key
Lab for Special Functional Materials, Ministry of Education, National
& Local Joint Engineering Research Center for High-efficiency
Display and Lighting Technology, School of Materials Science and Engineering,
and Collaborative Innovation Center of Nano Functional Materials and
Applications, Henan University, Kaifeng 475004, China
| | - Guangqin Gu
- Key
Lab for Special Functional Materials, Ministry of Education, National
& Local Joint Engineering Research Center for High-efficiency
Display and Lighting Technology, School of Materials Science and Engineering,
and Collaborative Innovation Center of Nano Functional Materials and
Applications, Henan University, Kaifeng 475004, China
| | - Minseob Shim
- Department
of Electronic Engineering, College of Engineering, Gyeongsang National University, 501, Jinjudae-ro, Gaho-dong, Jinju 52828, South Korea
| | - Jeehoon Jung
- Department
of Electrical Engineering, College of Information and Biotechnology, Ulsan National Institute of Science and Technology
(UNIST), 50, UNIST-gil, Eonyang-eup, Ulju-gun, Ulsan 44919, South Korea
| | - Changwoo Yun
- Department
of Electrical Engineering, College of Information and Biotechnology, Ulsan National Institute of Science and Technology
(UNIST), 50, UNIST-gil, Eonyang-eup, Ulju-gun, Ulsan 44919, South Korea
| | - Chi Zhang
- CAS
Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-nano
Energy and Sensor, Beijing Institute of
Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
- School
of Nanoscience and Technology, University
of Chinese Academy of Sciences, Beijing 100049, China
| | - Guoxu Liu
- CAS
Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-nano
Energy and Sensor, Beijing Institute of
Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
- School
of Nanoscience and Technology, University
of Chinese Academy of Sciences, Beijing 100049, China
| | - Yufeng Chen
- Department
of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Suhan Kim
- Department
of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Xiangyu Chen
- School
of Nanoscience and Technology, University
of Chinese Academy of Sciences, Beijing 100049, China
- CAS
Center for Excellence in Nanoscience, Beijing
Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, 100083 Beijing, China
| | - Jun Hu
- School
of Nanoscience and Technology, University
of Chinese Academy of Sciences, Beijing 100049, China
- CAS
Center for Excellence in Nanoscience, Beijing
Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, 100083 Beijing, China
| | - Xiong Pu
- School
of Nanoscience and Technology, University
of Chinese Academy of Sciences, Beijing 100049, China
- CAS
Center for Excellence in Nanoscience, Beijing
Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, 100083 Beijing, China
| | - Zi Hao Guo
- School
of Nanoscience and Technology, University
of Chinese Academy of Sciences, Beijing 100049, China
- CAS
Center for Excellence in Nanoscience, Beijing
Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, 100083 Beijing, China
| | - Xudong Wang
- Department
of Materials Science and Engineering, University
of Wisconsin−Madison, Madison, Wisconsin 53706, United States
| | - Jun Chen
- Department
of Bioengineering, University of California,
Los Angeles, Los Angeles, California 90095, United States
| | - Xiao Xiao
- Department
of Bioengineering, University of California,
Los Angeles, Los Angeles, California 90095, United States
| | - Xing Xie
- School
of Civil & Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Mourin Jarin
- School
of Civil & Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Hulin Zhang
- College
of Information and Computer, Taiyuan University
of Technology, Taiyuan 030024, P. R. China
| | - Ying-Chih Lai
- Department
of Materials Science and Engineering, National
Chung Hsing University, Taichung 40227, Taiwan
- i-Center
for Advanced Science and Technology, National
Chung Hsing University, Taichung 40227, Taiwan
- Innovation
and Development Center of Sustainable Agriculture, National Chung Hsing University, Taichung 40227, Taiwan
| | - Tianyiyi He
- Department
of Electrical and Computer Engineering, National University of Singapore, 4 Engineering Drive 3, 117576, Singapore
| | - Hakjeong Kim
- School
of Mechanical Engineering, College of Engineering, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
| | - Inkyu Park
- Department
of Mechanical Engineering, Korea Advanced
Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
| | - Junseong Ahn
- Department
of Mechanical Engineering, Korea Advanced
Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
| | - Nghia Dinh Huynh
- School
of Mechanical Engineering, College of Engineering, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
| | - Ya Yang
- CAS
Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-nano
Energy and Sensor, Beijing Institute of
Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
- School
of Nanoscience and Technology, University
of Chinese Academy of Sciences, Beijing 100049, China
- Center
on Nanoenergy Research, School of Physical Science and Technology, Guangxi University, Nanning 530004, P. R. China
| | - Zhong Lin Wang
- Beijing
Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
- School
of Nanoscience and Technology, University
of Chinese Academy of Sciences, Beijing 100049, China
- School
of Materials Science and Engineering, Georgia
Institute of Technology, Atlanta, Georgia 30332, United States
| | - Jeong Min Baik
- School
of Advanced Materials Science & Engineering, Sungkyunkwan University, Suwon 16419, Republic
of Korea
- SKKU
Institute of Energy Science and Technology (SIEST), Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
- KIST-SKKU
Carbon-Neutral Research Center, Sungkyunkwan
University (SKKU), Suwon 16419, Republic
of Korea
| | - Dukhyun Choi
- SKKU
Institute of Energy Science and Technology (SIEST), Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
- School
of Mechanical Engineering, College of Engineering, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi 16419, South Korea
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11
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Li AHY, Bhatia A, Gulati A, Ottestad E. Role of peripheral nerve stimulation in treating chronic neuropathic pain: an international focused survey of pain medicine experts. Reg Anesth Pain Med 2023; 48:312-318. [PMID: 37080584 DOI: 10.1136/rapm-2022-104073] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/02/2022] [Indexed: 04/22/2023]
Abstract
Interventional pain management (IPM) options for refractory neuropathic pain (NP) have recently increased with availability of peripheral nerve stimulation (PNS) equipment and expertise. Given a lack of high-quality evidence and guidelines on this topic, we sought to understand the perception of physicians with expertise in treating NP regarding IPM and the role of PNS. We emailed a survey in March 2022 to international NP experts including pain medicine physicians, researchers, and leaders of 11 professional pain societies. No representatives from vendors of PNS systems were included in the design of the survey nor as respondents. Among 24 respondents (67% of those contacted), the distal common peroneal, tibial, and sural nerves were most frequently targeted (60%) with PNS. Persistent postsurgical pain of more than 3 months was the most common indication for PNS (84%). The aggregate NP treatment algorithm in order of median rank was non-opioid medications as first line, IPM including epidural/perineural steroid injections tied with transcutaneous electrical nerve stimulation as second line, pulsed radiofrequency (RF) tied with RF ablation/denervation as third line, temporary then permanent PNS as fourth line, followed by spinal cord stimulation, opioids, cryoablation, botulinum, peripheral nerve field stimulation, intrathecal targeted drug delivery, and others. Before offering PNS, 12 respondents (50%) indicated their preference for trialing non-neuromodulation treatments for 1-3 months. Twenty-two respondents (92%) agreed PNS should be offered early in the treatment of neuropathic pain. The most common barriers to PNS use were cost, lack of high-quality evidence in support of its use, lack of exposure to PNS in training programs, and lack of familiarity with the use of ultrasound guidance. PNS appears to have an increasing role in the treatment of NP but more research is needed on the outcomes of PNS to elucidate its role.
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Affiliation(s)
- Alice Huai-Yu Li
- Department of Anesthesia, Stanford University, Stanford, California, USA
| | - Anuj Bhatia
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amit Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Einar Ottestad
- Anesthesiology and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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12
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Orhurhu V, Hussain N, Karri J, Mariano ER, Abd-Elsayed A. Perioperative and anesthetic considerations for the management of neuromodulation systems. Reg Anesth Pain Med 2023; 48:327-336. [PMID: 37080581 DOI: 10.1136/rapm-2022-103660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/04/2022] [Indexed: 04/22/2023]
Abstract
The use of neuromodulation systems is increasing for the treatment of various pathologies ranging from movement disorders to urinary incontinence to chronic pain syndromes. While the type of neuromodulation devices varies, they are largely categorized as intracranial (eg, deep brain stimulation), neuraxial (eg, spinal cord stimulation, dorsal root ganglion stimulation, and intrathecal drug delivery systems), or peripheral (eg, sacral nerve stimulation and peripheral nerve stimulation) systems. Given the increasing prevalence of these systems in the overall population, it is important for anesthesiologists, surgeons, and the perioperative healthcare team to familiarize themselves with these systems and their unique perioperative considerations. In this review, we explore and highlight the various neuromodulation systems, their general perioperative considerations, and notable special circumstances for perioperative management.
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Affiliation(s)
- Vwaire Orhurhu
- Anesthesiology, University of Pittsburgh Medical Center, Williamsport, Pennsylvania, USA
- Pain Medicine, MVM Health, East Stroudsburg, Pennsylvania, USA
| | - Nasir Hussain
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jay Karri
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Divsion of Pain Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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13
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López-de-Celis C, Fernández-de-Las-Peñas C, Malo-Urriés M, Albarova-Corral I, Arias-Buría JL, Pérez-Bellmunt A, Rodríguez-Sanz J, González-Rueda V, Borella-Andrés S. Precision of Ultrasound-Guided versus Anatomical Palpation-Guided Needle Placement of the Ulnar Nerve at the Cubital Tunnel: A Cadaveric Study. Healthcare (Basel) 2023; 11:healthcare11111603. [PMID: 37297743 DOI: 10.3390/healthcare11111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Percutaneous electrical stimulation has been performed for years with only the assistance of anatomical landmarks. The development of real-time ultrasonography guidance has improved the precision and safety of these percutaneous interventions. Despite ultrasound-guided and palpation-guided procedures being performed routinely for targeting nerve tissues in the upper extremity, the precision and safety of these techniques are unknown. The aim of this cadaveric study was to determine and compare the precision and safety of ultrasound-guided versus palpation-guided needling procedure with and without the handpiece of the ulnar nerve on a cadaveric model. Five physical therapists performed a series of 20 needle insertion tasks each (n = 100), 10 palpation-guided (n = 50) and 10 ultrasound-guided (n = 50) on cryopreserved specimens. The purpose of the procedure was to place the needle in proximity to the ulnar nerve at the cubital tunnel. The distance to target, time performance, accurate rate, number of passes, and unintentional puncture of surrounding structures were compared. The ultrasound-guided procedure was associated with higher accuracy (66% vs. 96%), lower distance from needle to the target (0.48 ± 1.37 vs. 2.01 ± 2.41 mm), and a lower frequency of perineurium puncture (0% vs. 20%) when compared with the palpation-guided procedure. However, the ultrasound-guided procedure required more time (38.33 ± 23.19 vs. 24.57 ± 17.84 s) than the palpation-guided procedure (all, p < 0.001). Our results support the assumption that ultrasound guidance improves the accuracy of needling procedures on the ulnar nerve at the cubital tunnel when compared with palpation guidance.
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Affiliation(s)
- Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
- Fundació Institut, Universitari per a La Recerca a l'Atenció, Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08028 Barcelona, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Miguel Malo-Urriés
- Health Sciences Faculty, Department of Physiatry and Nursery, University of Zaragoza, 50009 Zaragoza, Spain
| | - Isabel Albarova-Corral
- Health Sciences Faculty, Department of Physiatry and Nursery, University of Zaragoza, 50009 Zaragoza, Spain
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
| | - Vanessa González-Rueda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, 08028 Barcelona, Spain
- ACTIUM Functional Anatomy Group, 08028 Barcelona, Spain
- Fundació Institut, Universitari per a La Recerca a l'Atenció, Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08028 Barcelona, Spain
| | - Sergio Borella-Andrés
- Health Sciences Faculty, Department of Physiatry and Nursery, University of Zaragoza, 50009 Zaragoza, Spain
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14
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Beauchene C, Zurn CA, Ehrens D, Duff I, Duan W, Caterina M, Guan Y, Sarma SV. Steering Toward Normative Wide-Dynamic-Range Neuron Activity in Nerve-Injured Rats With Closed-Loop Peripheral Nerve Stimulation. Neuromodulation 2023; 26:552-562. [PMID: 36402658 PMCID: PMC10081946 DOI: 10.1016/j.neurom.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/08/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Chronic pain is primarily treated with pharmaceuticals, but the effects remain unsatisfactory. A promising alternative therapy is peripheral nerve stimulation (PNS), but it has been associated with suboptimal efficacy because its modulation mechanisms are not clear and the current therapies are primarily open loop (ie, manually adjusting the stimulation parameters). In this study, we developed a proof-of-concept computational modeling as the first step toward implementing closed-loop PNS in future biological studies. When developing new pain therapies, a useful pain biomarker is the wide-dynamic-range (WDR) neuron activity in the dorsal horn. In healthy animals, the WDR neuron activity occurs in a stereotyped manner; however, this response profile can vary widely after nerve injury to create a chronic pain condition. We hypothesized that if injury-induced changes of neuronal response can be normalized to resemble those of a healthy condition, the pathological aspects of pain may be treated while maintaining protective physiological nociception. MATERIALS AND METHODS Using an in vivo electrophysiology data set of WDR neuron recordings obtained in nerve-injured rats and naïve rats, we constructed sets of linear phenomenologic models of WDR firing rate during windup stimulation for both conditions. Then, we applied robust control systems techniques to identify a closed-loop PNS controller, which can drive the dynamics of WDR neuron response in neuropathic pain model into ranges associated with normal physiological pain. RESULTS The sets of identified linear models can accurately predict, in silico, nonlinear neural responses to electrical stimulation of the peripheral nerve. In addition, we showed that continuous closed-loop control of PNS can be used to normalize WDR neuron firing responses in three injured cases. CONCLUSIONS In this proof-of-concept study, we show how tractable, linear mathematical models of pain-related neurotransmission can be used to inform the development of closed-loop PNS. This new application of robust control to neurotechnology may also be expanded and applied across other neuromodulation applications.
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Affiliation(s)
- Christine Beauchene
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Claire A Zurn
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Ehrens
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Irina Duff
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wanru Duan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Caterina
- Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yun Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Neurosurgery Pain Research Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sridevi V Sarma
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, USA.
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15
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Dorrian RM, Berryman CF, Lauto A, Leonard AV. Electrical stimulation for the treatment of spinal cord injuries: A review of the cellular and molecular mechanisms that drive functional improvements. Front Cell Neurosci 2023; 17:1095259. [PMID: 36816852 PMCID: PMC9936196 DOI: 10.3389/fncel.2023.1095259] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that causes severe loss of motor, sensory and autonomic functions. Additionally, many individuals experience chronic neuropathic pain that is often refractory to interventions. While treatment options to improve outcomes for individuals with SCI remain limited, significant research efforts in the field of electrical stimulation have made promising advancements. Epidural electrical stimulation, peripheral nerve stimulation, and functional electrical stimulation have shown promising improvements for individuals with SCI, ranging from complete weight-bearing locomotion to the recovery of sexual function. Despite this, there is a paucity of mechanistic understanding, limiting our ability to optimize stimulation devices and parameters, or utilize combinatorial treatments to maximize efficacy. This review provides a background into SCI pathophysiology and electrical stimulation methods, before exploring cellular and molecular mechanisms suggested in the literature. We highlight several key mechanisms that contribute to functional improvements from electrical stimulation, identify gaps in current knowledge and highlight potential research avenues for future studies.
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Affiliation(s)
- Ryan M. Dorrian
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia,*Correspondence: Ryan M. Dorrian,
| | | | - Antonio Lauto
- School of Science, Western Sydney University, Penrith, NSW, Australia
| | - Anna V. Leonard
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
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16
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Mishra LN, Kulkarni G, Gadgil M. Modeling the Impact of the Variation in Peripheral Nerve Anatomy on Stimulation. J Pain Res 2022; 15:4097-4111. [PMID: 36605407 PMCID: PMC9809380 DOI: 10.2147/jpr.s380546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/06/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction The peripheral nervous system has a complex anatomical structure. Stimulation of nerve fibers in the peripheral nervous system depends on the fiber diameter and myelination as well as its location within the nerve, packing fraction and fascicle distribution within the nerve bundle. This paper analyzes the impact of the variation in peripheral nervous system anatomy and the distance of the stimulating electrodes on the probability of generating an action potential. Methods A mathematical model for effective fascicle conductivity has been developed to capture the variation in the packing fraction and fiber diameter. A linear activating function is utilized to analyze the impact of this effective conductivity and fascicle distribution as an indicator of generating an action potential. Results Finite element simulations are performed for the nerve-electrode configuration to evaluate the electric field. The simulation results are used to analyze the activating function for different packing fractions and type of nerve fibers. The effect of electrode distance on activating function and the total current through a nerve bundle has also been studied. Discussion The simulation results indicate that the peripheral nerve anatomy and electrode distance have a significant effect on the action potential generation.
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Affiliation(s)
- Lakshmi Narayan Mishra
- Nalu Medical Inc., Carlsbad, CA, USA,Correspondence: Lakshmi Narayan Mishra, Nalu Medical Inc., 2320 Faraday Avenue, Suite 100, Carlsbad, CA, 92008, USA, Tel +1 760-448-2360, Email
| | | | - Mandar Gadgil
- Oneirix Engineering Laboratories Pvt. Ltd., Pune, MH, India
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17
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Kalia H, Abd-Elsayed A, Malinowski M, Burkey A, Abdallah RT, Sivanesan E, Malik T, Tolba R, Eshraghi Y, Ferguson K, Schnur M, Raslan A, Guirguis M, Russo M, Slavin KV. Educational Curriculum for Peripheral Nerve Stimulation Developed by the North American Neuromodulation Society. Neuromodulation 2022; 26:483-489. [PMID: 36526547 DOI: 10.1016/j.neurom.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral nerve stimulation (PNS) is an effective neuromodulation therapy for chronic neuropathic and nociceptive pain. Although the total number of PNS implantations has increased over the last decade, no curriculum exists to guide training and learning of this therapy. The goal of the North American Neuromodulation Society (NANS) education committee is to develop a series of competency-based curriculums for neuromodulation therapies. The PNS curriculum is the latest part of such series, following the curriculums for spinal cord stimulation and intrathecal drug delivery system. MATERIALS AND METHODS A multidisciplinary task force (anesthesiology, physical medicine and rehabilitation, neurosurgery, preventive medicine and public health, and neurology) was created by the educational committee of NANS to develop a PNS curriculum in accordance with the Accreditation Council for Graduate Medical Education (ACGME) milestones. The curriculum was created based on the best available evidence and expert knowledge (from our task force members) of available PNS systems. The final PNS curriculum was approved by the NANS board. RESULTS A PNS curriculum was developed by the task force. Milestones included professionalism, practice-based learning, interpersonal communication, medical knowledge, systems-based practice, procedural skills, and patient care. Each milestone was defined into three categories: early learner, advanced learner, and practitioner. CONCLUSIONS This manuscript provides a PNS training curriculum developed by a multidisciplinary task force of the NANS educational committee in accordance with the milestones described by ACGME for basic learners, advanced learners, and practitioners. This curriculum will help provide a structured training and evaluation process for obtaining proficiency in PNS treatment(s).
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Collins MN, Mesce KA. A review of the bioeffects of low-intensity focused ultrasound and the benefits of a cellular approach. Front Physiol 2022; 13:1047324. [PMID: 36439246 PMCID: PMC9685663 DOI: 10.3389/fphys.2022.1047324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/25/2022] [Indexed: 10/28/2023] Open
Abstract
This review article highlights the historical developments and current state of knowledge of an important neuromodulation technology: low-intensity focused ultrasound. Because compelling studies have shown that focused ultrasound can modulate neuronal activity non-invasively, especially in deep brain structures with high spatial specificity, there has been a renewed interest in attempting to understand the specific bioeffects of focused ultrasound at the cellular level. Such information is needed to facilitate the safe and effective use of focused ultrasound to treat a number of brain and nervous system disorders in humans. Unfortunately, to date, there appears to be no singular biological mechanism to account for the actions of focused ultrasound, and it is becoming increasingly clear that different types of nerve cells will respond to focused ultrasound differentially based on the complement of their ion channels, other membrane biophysical properties, and arrangement of synaptic connections. Furthermore, neurons are apparently not equally susceptible to the mechanical, thermal and cavitation-related consequences of focused ultrasound application-to complicate matters further, many studies often use distinctly different focused ultrasound stimulus parameters to achieve a reliable response in neural activity. In this review, we consider the benefits of studying more experimentally tractable invertebrate preparations, with an emphasis on the medicinal leech, where neurons can be studied as unique individual cells and be synaptically isolated from the indirect effects of focused ultrasound stimulation on mechanosensitive afferents. In the leech, we have concluded that heat is the primary effector of focused ultrasound neuromodulation, especially on motoneurons in which we observed a focused ultrasound-mediated blockade of action potentials. We discuss that the mechanical bioeffects of focused ultrasound, which are frequently described in the literature, are less reliably achieved as compared to thermal ones, and that observations ascribed to mechanical responses may be confounded by activation of synaptically-coupled sensory structures or artifacts associated with electrode resonance. Ultimately, both the mechanical and thermal components of focused ultrasound have significant potential to contribute to the sculpting of specific neural outcomes. Because focused ultrasound can generate significant modulation at a temperature <5°C, which is believed to be safe for moderate durations, we support the idea that focused ultrasound should be considered as a thermal neuromodulation technology for clinical use, especially targeting neural pathways in the peripheral nervous system.
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Affiliation(s)
- Morgan N. Collins
- Graduate Program in Neuroscience, University of Minnesota, Saint Paul, MN, United States
| | - Karen A. Mesce
- Department of Entomology and Graduate Program in Neuroscience, University of Minnesota, Saint Paul, MN, United States
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Yaccarino V, Jin MY, Abd-Elsayed A, Kraemer JM, Sehgal N. Peripheral Nerve Stimulation in Painful Conditions of the Upper Extremity-An Overview. Biomedicines 2022; 10:2776. [PMID: 36359295 PMCID: PMC9687108 DOI: 10.3390/biomedicines10112776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 08/01/2023] Open
Abstract
Our objective is to present a brief history of the evolution of peripheral nerve stimulation, the current understanding of peripheral nerve stimulation mechanisms in chronic pain, peripheral nerve stimulation applications in upper extremity chronic pain conditions, and complications of peripheral nerve stimulation. The evolution of peripheral nerve stimulation from the early ages to the current status has been facilitated by discoveries in neurobehavioral mechanisms of pain, advances in technology and percutaneous lead development, and the availability of high-quality portable ultrasound units. Peripheral nerve stimulation application in managing upper extremity pain of amputated limbs, post-stroke shoulder pain, complex regional pain syndrome (CRPS), and median, ulnar, and radial neuropathies are discussed. Finally, we describe complications of peripheral nerve stimulation. The availability of ultrasound-guided peripheral nerve stimulation techniques and superior peripheral nerve stimulation technology have opened up new and minimally invasive treatment options for chronic intractable neuropathic pain of the upper extremity. Additionally, the ability to place peripheral nerve stimulation leads percutaneously without open peripheral nerve surgery expands the pool of implanting physicians, while simultaneously decreasing the risks and complications that are associated with open surgery.
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Affiliation(s)
- Vincent Yaccarino
- Department of Orthopedics & Rehabilitation, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, USA
| | - Max Y. Jin
- Department of Anesthesiology, University of Wisconsin, Madison, WI 53792, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI 53792, USA
| | | | - Nalini Sehgal
- Department of Orthopedics & Rehabilitation, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, USA
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20
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Fidalgo-Martin I, Ramos-Álvarez JJ, Murias-Lozano R, Rodríguez-López ES. Effects of percutaneous neuromodulation in neuromusculoskeletal pathologies: A systematic review. Medicine (Baltimore) 2022; 101:e31016. [PMID: 36254060 PMCID: PMC9575779 DOI: 10.1097/md.0000000000031016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Percutaneous neuromodulation (PNM) consists in using electrical stimulation on a peripheral nerve by using a needle as an electrode in order to lessen the pain and restore both neuromuscular and nervous system functions. The aims of the present study were to evaluate the current scientific evidence of the effects of PNM on pain and physical capabilities in neuromusculoskeletal injuries. METHODS Data sources: There was used the PRISMA protocol. In order to do the literature research, there were used the PubMed, Cochrane, Scopus, and Web of Science databases. Study selection or eligibility criteria: There were also included experimental clinical trials published between 2010 and nowadays, tested on humans, which feature treatment based on needles with electrical stimulation in order to treat neuromusculoskeletal injuries. Study appraisal and synthesis methods: A quality assessment was performed according to the PEDro scale and reviewed the impact factor and quartile of the journal. RESULTS The treatment resulted in significant improvement in terms of pain intensity, pressure pain threshold, balance, muscular endurance, functionality/disability, subjective improvement, function of the descending pain modulatory system, and intake of drugs. Limitations: the lack of previous research studies on the subject and the lack of data on opioid intake in the selected studies. CONCLUSION Treatment based on PNM may be an alternative when treating injuries in soft tissues without significant side effects. However, there are few articles investigating the effects of PNM so more evidence is needed to draw solid conclusions.
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Affiliation(s)
| | - Juan José Ramos-Álvarez
- School of Sports Medicine, Universidad Complutense de Madrid, Pza Ramón y Cajal, Madrid, Spain
- *Correspondence: Juan José Ramos-Álvarez, School of Sports Medicine, Universidad Complutense de Madrid. Plaza Ramón y Cajal, 1. 28040 Madrid, Spain (e-mail: )
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21
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Chu XL, Song XZ, Li Q, Li YR, He F, Gu XS, Ming D. Basic mechanisms of peripheral nerve injury and treatment via electrical stimulation. Neural Regen Res 2022; 17:2185-2193. [PMID: 35259827 PMCID: PMC9083151 DOI: 10.4103/1673-5374.335823] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Previous studies on the mechanisms of peripheral nerve injury (PNI) have mainly focused on the pathophysiological changes within a single injury site. However, recent studies have indicated that within the central nervous system, PNI can lead to changes in both injury sites and target organs at the cellular and molecular levels. Therefore, the basic mechanisms of PNI have not been comprehensively understood. Although electrical stimulation was found to promote axonal regeneration and functional rehabilitation after PNI, as well as to alleviate neuropathic pain, the specific mechanisms of successful PNI treatment are unclear. We summarize and discuss the basic mechanisms of PNI and of treatment via electrical stimulation. After PNI, activity in the central nervous system (spinal cord) is altered, which can limit regeneration of the damaged nerve. For example, cell apoptosis and synaptic stripping in the anterior horn of the spinal cord can reduce the speed of nerve regeneration. The pathological changes in the posterior horn of the spinal cord can modulate sensory abnormalities after PNI. This can be observed in cases of ectopic discharge of the dorsal root ganglion leading to increased pain signal transmission. The injured site of the peripheral nerve is also an important factor affecting post-PNI repair. After PNI, the proximal end of the injured site sends out axial buds to innervate both the skin and muscle at the injury site. A slow speed of axon regeneration leads to low nerve regeneration. Therefore, it can take a long time for the proximal nerve to reinnervate the skin and muscle at the injured site. From the perspective of target organs, long-term denervation can cause atrophy of the corresponding skeletal muscle, which leads to abnormal sensory perception and hyperalgesia, and finally, the loss of target organ function. The mechanisms underlying the use of electrical stimulation to treat PNI include the inhibition of synaptic stripping, addressing the excessive excitability of the dorsal root ganglion, alleviating neuropathic pain, improving neurological function, and accelerating nerve regeneration. Electrical stimulation of target organs can reduce the atrophy of denervated skeletal muscle and promote the recovery of sensory function. Findings from the included studies confirm that after PNI, a series of physiological and pathological changes occur in the spinal cord, injury site, and target organs, leading to dysfunction. Electrical stimulation may address the pathophysiological changes mentioned above, thus promoting nerve regeneration and ameliorating dysfunction.
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Affiliation(s)
- Xiao-Lei Chu
- Academy of Medical Engineering and Translational Medicine, Tianjin University; Department of Rehabilitation, Tianjin Hospital, Tianjin, China
| | - Xi-Zi Song
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Qi Li
- Academy of Medical Engineering and Translational Medicine, Tianjin University; Department of Rehabilitation, Tianjin Hospital, Tianjin, China
| | - Yu-Ru Li
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Feng He
- College of Precision Instruments & Optoelectronics Engineering, Tianjin University, Tianjin, China
| | - Xiao-Song Gu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine; College of Precision Instruments & Optoelectronics Engineering, Tianjin University, Tianjin, China
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22
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Hagedorn JM, Pittelkow TP, Bendel MA, Moeschler SM, Orhurhu V, Sanchez-Sotelo J. The painful shoulder arthroplasty: appropriate work-up and review of interventional pain treatments. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:269-276. [PMID: 37588877 PMCID: PMC10426573 DOI: 10.1016/j.xrrt.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Shoulder arthroplasty is a successful surgical procedure for several conditions when patients become refractory to conservative management modalities. Unfortunately, some patients experience persistent chronic pain after shoulder arthroplasty. These individuals should undergo a comprehensive evaluation by an orthopedic surgeon to determine whether structural pathology is responsible for the pain and to decide whether reoperation is indicated. At times, a surgical solution does not exist. In these circumstances, a thorough and specific plan for the management of persistent chronic pain should be developed and instituted. In this article, we review common reasons for persistent pain after shoulder arthroplasty and outline the evaluation of the painful shoulder arthroplasty. We then provide a thorough review of interventional pain management strategies. Finally, we hypothesize developments in our field that might provide better outcomes in the future for patients suffering with chronic intractable pain after shoulder arthroplasty.
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Affiliation(s)
- Jonathan M. Hagedorn
- Corresponding author: Jonathan M. Hagedorn, MD, Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Thomas P. Pittelkow
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Markus A. Bendel
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Susan M. Moeschler
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Vwaire Orhurhu
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joaquin Sanchez-Sotelo
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Strand N, J M, Tieppo Francio V, M M, Turkiewicz M, El Helou A, M M, S C, N S, J P, C W. Advances in Pain Medicine: a Review of New Technologies. Curr Pain Headache Rep 2022; 26:605-616. [PMID: 35904729 PMCID: PMC9334973 DOI: 10.1007/s11916-022-01062-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
Purpose of Review This narrative review highlights the interventional musculoskeletal techniques that have evolved in recent years. Recent Findings The recent progress in pain medicine technologies presented here represents the ideal treatment of the pain patient which is to provide personalized care. Advances in pain physiology research and pain management technologies support each other concurrently. Summary As new technologies give rise to new perspectives and understanding of pain, new research inspires the development of new technologies
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Affiliation(s)
- Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA. .,NorthShore University HealthSystem, Evanston, IL, USA. .,University of Chicago Medicine, Chicago, IL, USA.
| | - Maloney J
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, The University of Kansas Medical Center (KUMC), 3901 Rainbow Blvd. MS1046, Kansas City, KS, 66160, USA
| | - Murphy M
- Department of Rehabilitation Medicine, The University of Kansas Medical Center (KUMC), 3901 Rainbow Blvd. MS1046, Kansas City, KS, 66160, USA
| | | | - Antonios El Helou
- Department of Neurosurgery, The Moncton Hospital, Moncton, NB, Canada
| | - Maita M
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Covington S
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Singh N
- OrthoAlabama Spine and Sports, Birmingham, AL, USA
| | - Peck J
- Performing Arts Medicine Department, Shenandoah University, Winchester, VA, USA
| | - Wie C
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
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24
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Peripheral Nerve Stimulation for Chronic Pain and Migraine. Phys Med Rehabil Clin N Am 2022; 33:379-407. [DOI: 10.1016/j.pmr.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Li AH, Gulati A, Leong MS, Aggarwal AK, Salmasi V, Spinner D, Ottestad E. Considerations in Permanent Implantation of Peripheral Nerve Stimulation (PNS) for Chronic Neuropathic Pain: An International Cross Sectional Survey of Implanters. Pain Pract 2022; 22:508-515. [PMID: 35178863 DOI: 10.1111/papr.13105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/11/2022] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Novel minimally invasive short-term and long-term peripheral nerve stimulation (PNS) systems have revolutionized targeted treatment of chronic neuropathic pain. We present an international survey of PNS-implanting pain physicians to assess what factors they consider when offering permanent PNS. METHODS This cross-sectional study consisted of a survey (Qualtrics) that was distributed to PNS-implanting physicians in a device supplier's entire email database on November 13, 2020, with 3 weeks of response time. Physicians' contact information in the form of their email addresses had been previously collected by the supplier upon device distribution with permission to use survey responses for research. RESULTS Of 2,032 database physicians, 40 physicians representing 37 institutions responded to the survey. The most common application of PNS was mononeuropathic pain (57%). The most frequently targeted nerve was the suprascapular nerve (29%). 14% of physicians reported 81-100% of their implants were dual-lead. The representative physicians ranged broadly in their most frequently-targeted nerves. Although mononeuropathic pain was the most common indication for PNS, there was still varied response regarding other indications such as CRPS and post-surgical chronic pain. CONCLUSION In context of a low response rate, identifying such factors can help update the prevailing treatment algorithm for interventional therapies, assist pain physicians in better identifying which patients are the best candidates for PNS, and inform future clinical trial design on PNS efficacy.
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Affiliation(s)
- Alice H Li
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
| | - Amitabh Gulati
- Department of Chronic Pain, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Michael S Leong
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
| | - Anuj K Aggarwal
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
| | - Vafi Salmasi
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
| | - David Spinner
- Department of Rehabilitation and Human Performance, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Einar Ottestad
- Department of Anesthesiology Perioperative and Pain Medicine, Stanford Stanford, CA, USA
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Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy. Pain Ther 2021; 10:961-972. [PMID: 34331668 PMCID: PMC8586305 DOI: 10.1007/s40122-021-00298-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022] Open
Abstract
Chronic pain is a common source of morbidity in many patient populations worldwide. There are growing concerns about the potential side effects of currently prescribed medications and a continued need for effective treatment. Related to these concerns, peripheral nerve stimulation has been regaining popularity as a potential treatment modality. Peripheral nerve stimulation components include helically coiled electrical leads, which direct an applied current to afferent neurons providing sensory innervation to the painful area. In theory, the applied current to the peripheral nerve will alter the large-diameter myelinated afferent nerve fibers, which interfere with the central processing of pain signals through small-diameter afferent fibers at the level of the spinal cord. Multiple studies have shown success in the use of peripheral nerve stimulation for acute post-surgical pain for orthopedic surgery, including post total knee arthroplasty and anterior cruciate ligament surgery, and chronic knee pain. Many studies have investigated the utility of peripheral nerve stimulation for the management of chronic shoulder pain. Peripheral nerve stimulation also serves as one of the potential non-pharmacologic therapies to treat back pain along with physical therapy, application of transcutaneous electrical neurostimulation unit, radiofrequency ablation, epidural steroid injections, permanently implanted neurostimulators, and surgery. Studies regarding back pain treatment have shown that peripheral nerve stimulation led to significant improvement in all pain and quality-of-life measures and a reduction in the use of opioids. Further studies are needed as the long-term risks and benefits of peripheral nerve stimulation have not been well studied as most information available on the effectiveness of peripheral nerve stimulation is based on shorter-term improvements in chronic pain.
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27
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Malinowski MN, Chopra PR, Tieppo Francio V, Budwany R, Deer TR. A narrative review and future considerations of spinal cord stimulation, dorsal root ganglion stimulation and peripheral nerve stimulation. Curr Opin Anaesthesiol 2021; 34:774-780. [PMID: 34608057 DOI: 10.1097/aco.0000000000001072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW In recent years, neuromodulation has experienced a renaissance. Novel waveforms and anatomic targets show potential improvements in therapy that may signify substantial benefits. New innovations in peripheral nerve stimulation and dorsal root ganglion stimulation have shown prospective evidence and sustainability of results. Sub-perception physiologic bursting, high-frequency stimulation and feedback loop mechanisms provide significant benefits over traditional tonic spinal cords stimulation (SCS) in peer reviewed investigations. We reviewed the themes associated with novel technology in the context of historical stalwart publications. RECENT FINDINGS New innovations have led to better nerve targeting, improvements in disease-based treatment, and opioid alternatives for those in chronic pain. In addition, new neural targets from both structural and cellular perspectives have changed the field of Neurostimulation. SUMMARY For many years, tonic SCS was representative of neuromodulation, but as this review examines, the progression of the field in the past decade has reshaped patient options.
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Affiliation(s)
- Mark N Malinowski
- OhioHealth Grant Medical Center, Ohio University Heritage COM, Columbus, Ohio
| | | | - Vinicius Tieppo Francio
- The University of Kansas Medical Center, Department of Rehabilitative Medicine, Kansas City, Kansas
| | - Ryan Budwany
- Center for Integrative Pain Management, West Virginia University School of Medicine, Morgantown
| | - Timothy Ray Deer
- The Spine and Nerve Center of The Virginias
- Anesthesiology and Pain Medicine, WVU School of Medicine
- American Society of Pain and Neuroscience, Charleston, West Virginia, USA
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28
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Jin F, Li T, Yuan T, Du L, Lai C, Wu Q, Zhao Y, Sun F, Gu L, Wang T, Feng ZQ. Physiologically Self-Regulated, Fully Implantable, Battery-Free System for Peripheral Nerve Restoration. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2104175. [PMID: 34608668 DOI: 10.1002/adma.202104175] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/14/2021] [Indexed: 06/13/2023]
Abstract
The long-segment peripheral nerve injury (PNI) represents a global medical challenge, leading to incomplete nerve tissue recovery and unsatisfactory functional reconstruction. However, the current electrical stimulation (ES) apparatuses fail perfect nerve repair due to their inability of the variable synchronous self-regulated function with physiological states. It is urgent to develop an implantable ES platform with physiologically adaptive function to provide instantaneous and nerve-preferred ES. Here, a physiologically self-regulated electrical signal is generated by integrating a novel tribo/piezoelectric hybrid nanogenerator with a nanoporous nerve guide conduit to construct a fully implantable neural electrical stimulation (FI-NES) system. The optimal neural ES parameters completely originate from the body itself and are highly self-responsive to different physiological states. The morphological evaluation, representative protein expression level, and functional reconstruction of the regenerated nerves are conducted to assess the PNI recovery process. Evidence shows that the recovery effect of 15 mm length nerve defects under the guidance of the FI-NES system is significantly close to the autograft. The designed FI-NES system provides an effective method for long-term accelerating the recovery of PNI in vivo and is also appropriate for other tissue injury or neurodegenerative diseases.
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Affiliation(s)
- Fei Jin
- School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, P. R. China
| | - Tong Li
- School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, P. R. China
| | - Tao Yuan
- Department of Orthopedic, Nanjing Jinling Hospital, Nanjing, 210002, P. R. China
| | - Lijuan Du
- School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, P. R. China
| | - Chengteng Lai
- Department of Orthopedic, Nanjing Jinling Hospital, Nanjing, 210002, P. R. China
- Medical School of Nanjing University, Nanjing University, Nanjing, 210002, P. R. China
| | - Qi Wu
- Department of Orthopedic, Nanjing Jinling Hospital, Nanjing, 210002, P. R. China
- Medical School of Nanjing University, Nanjing University, Nanjing, 210002, P. R. China
| | - Ying Zhao
- School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, P. R. China
| | - Fengyu Sun
- School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, P. R. China
| | - Long Gu
- School of Advanced Materials and Nanotechnology, Xidian University, Xi'an, 710071, P. R. China
| | - Ting Wang
- State Key Laboratory of Bioelectronics, Southeast University, Nanjing, 210096, P. R. China
| | - Zhang-Qi Feng
- School of Chemistry and Chemical Engineering, Nanjing University of Science and Technology, Nanjing, 210094, P. R. China
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Peripheral Nerve Stimulation for Treatment of Headaches: An Evidence-Based Review. Biomedicines 2021; 9:biomedicines9111588. [PMID: 34829819 PMCID: PMC8615534 DOI: 10.3390/biomedicines9111588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/15/2021] [Accepted: 10/26/2021] [Indexed: 01/06/2023] Open
Abstract
Headaches are one of the most common medical complaints worldwide, and treatment is often made difficult because of misclassification. Peripheral nerve stimulation has emerged as a novel treatment for the treatment of intractable headaches in recent years. While high-quality evidence does exist regarding its use, efficacy is generally limited to specific nerves and headache types. While much research remains to bring this technology to the mainstream, clinicians are increasingly able to provide safe yet efficacious pain control.
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30
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Górecki M, Czarnecki P. The influence of shoulder arthrodesis on the function of the upper limb in adult patients after a brachial plexus injury: a systematic literature review with elements of meta-analysis. EFORT Open Rev 2021; 6:797-807. [PMID: 34667651 PMCID: PMC8489470 DOI: 10.1302/2058-5241.6.200114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Based on the literature, 294 shoulder arthrodeses after brachial plexus injury in adults were assessed, mostly male; the mean age of the patients was 33 years, and the mean follow-up time was 5.5 years. The most common cause of injury was a traffic accident, especially on a motorcycle. Arthrodesis position ranged from 15 to 40 degrees of flexion, 15 to 60 degrees of abduction, and 0 to 50 degrees of internal rotation with the predominance of position by the 30-30-30 rule. Plates, screws, and external fixation were used for stabilization. The complication rate was at the level of 28%, the most common complication being delayed union or nonunion. Active movements of flexion and abduction averaged 61 and 56 degrees, respectively, while reaching the hand to the mouth, front pocket, and buttock was feasible for 69%, 71%, and 38%, respectively, after surgery. Shoulder pain was present in 77% of patients, and 28% experienced no relevant pain reduction after surgery. The subjective satisfaction rate was 82% based on significant improvement and satisfaction reported by patients after arthrodesis. Arthrodesis of the shoulder, in adult patients after brachial plexus palsy, can reduce shoulder pain, increase stability, and result in a range of motion that increases the possibility of carrying out everyday activities. This affects the high level of subjective patient satisfaction after surgery.
Cite this article: EFORT Open Rev 2021;6:797-807. DOI: 10.1302/2058-5241.6.200114
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Affiliation(s)
- Michał Górecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
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Persaud-Sharma D, William Mallet J, Panjeton GD, Ogbemudia B, Ahmad A, Coombes S, Antony A. Neuromodulation Applications for Chronic Pain. J Med Device 2021. [DOI: 10.1115/1.4052123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
Chronic back pain is highly prevalent worldwide, affecting over 10% of the global population. It is a complex medical problem that affects individuals, families, and communities and has a costly economic impact through an impaired workforce. Pain mechanisms are complicated and include biological, psychological, and social components that can combine to drive unique pain experiences. Beyond conservative management with multimodal pharmacotherapy and more invasive surgical intervention for an identifiable anatomical abnormality, there are limited therapies for the resolution of chronic pain. However, exciting technological developments in spinal cord stimulation have renewed interest in neuromodulation for patients with refractory pain after both conservative and surgical management. Here, we review the efficacy of spinal cord stimulator technologies and other related technologies, including dorsal root ganglion stimulators and peripheral nerve stimulators, as well as highlight future areas of research.
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Affiliation(s)
- Dharam Persaud-Sharma
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - John William Mallet
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - Geoffrey Danial Panjeton
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - Blessing Ogbemudia
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - Affan Ahmad
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610-0254
| | - Stephen Coombes
- Department of Applied Physiology and Kinesiology, University of Florida College of Health and Human Performance, 1864 Stadium Road, Gainesville, FL 32611
| | - Ajay Antony
- The Orthopedic Institute, 4500 W Newberry Road, Gainesville, FL 32607
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Zhao L, Song T. Case Report: Short-Term Spinal Cord Stimulation and Peripheral Nerve Stimulation for the Treatment of Trigeminal Postherpetic Neuralgia in Elderly Patients. Front Neurol 2021; 12:713366. [PMID: 34413827 PMCID: PMC8368125 DOI: 10.3389/fneur.2021.713366] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: We aimed to report on the use of short-term high cervical spinal cord stimulation (SCS) combined with peripheral nerve stimulation (PNS) to successfully treat trigeminal postherpetic neuralgia (TPHN) affecting the V2 and V3 divisions. We also sought to use a novel PNS approach to the maxillary nerve next to the external opening of the foramen rotundum (FR) to treat TPHN at the V2 division. Method: Two elderly patients successfully treated with different neuromodulation methods for TPHN are presented in this case series. Results: The first case referred to an 83-year-old Chinese female patient with V2 and V3 TPHN who experienced a significant pain relief using a combination of short-term high cervical SCS at the C1–C2 level and PNS on the infraorbital nerve (ION). Case 2 was a 68-year-old Chinese male patient with V1 and V2 TPHN that obtained an excellent pain relief after having received short-term PNS on the supraorbital nerve (SON), the supratrochlear nerve (STN), and the maxillary nerve. Both reported improvements in their quality of life and ability to perform daily tasks during a 3-month follow-up period. Conclusions: Short-term high cervical SCS at the C1–C2 spinal segments may be a feasible method to treat recent-onset V3 TPHN in elderly patients. Additionally, by placing the stimulation lead next to the external FR opening, we demonstrated a novel PNS approach to the maxillary nerve not previously reported for TPHN therapy.
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Affiliation(s)
- Lin Zhao
- Department of Pain, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Tao Song
- Department of Pain, The First Affiliated Hospital of China Medical University, Shenyang, China
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Garrett A, Rakhilin N, Wang N, McKey J, Cofer G, Anderson RB, Capel B, Johnson GA, Shen X. Mapping the peripheral nervous system in the whole mouse via compressed sensing tractography. J Neural Eng 2021; 18. [PMID: 33979784 DOI: 10.1088/1741-2552/ac0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/12/2021] [Indexed: 11/12/2022]
Abstract
Objective.The peripheral nervous system (PNS) connects the central nervous system with the rest of the body to regulate many physiological functions and is therapeutically targeted to treat diseases such as epilepsy, depression, intestinal dysmotility, chronic pain, and more. However, we still lack understanding of PNS innervation in most organs because the large span, diffuse nature, and small terminal nerve bundle fibers have precluded whole-organism, high resolution mapping of the PNS. We sought to produce a comprehensive peripheral nerve atlas for use in future interrogation of neural circuitry and selection of targets for neuromodulation.Approach.We used diffusion tensor magnetic resonance imaging (DT-MRI) with high-speed compressed sensing to generate a tractogram of the whole mouse PNS. The tractography generated from the DT-MRI data is validated using lightsheet microscopy on optically cleared, antibody stained tissue.Main results.Herein we demonstrate the first comprehensive PNS tractography in a whole mouse. Using this technique, we scanned the whole mouse in 28 h and mapped PNS innervation and fiber network in multiple organs including heart, lung, liver, kidneys, stomach, intestines, and bladder at 70µm resolution. This whole-body PNS tractography map has provided unparalleled information; for example, it delineates the innervation along the gastrointestinal tract by multiple sacral levels and by the vagal nerves. The map enabled a quantitative tractogram that revealed relative innervation of the major organs by each vertebral foramen as well as the vagus nerve.Significance.This novel high-resolution nerve atlas provides a potential roadmap for future neuromodulation therapies and other investigations into the neural circuits which drive homeostasis and disease throughout the body.
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Affiliation(s)
- Aliesha Garrett
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States of America
| | - Nikolai Rakhilin
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States of America
| | - Nian Wang
- Duke Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
| | - Jennifer McKey
- Department of Cell Biology, School of Medicine, Duke University, Durham, NC, United States of America
| | - Gary Cofer
- Duke Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
| | - Robert Bj Anderson
- Duke Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
| | - Blanche Capel
- Department of Cell Biology, School of Medicine, Duke University, Durham, NC, United States of America
| | - G Allan Johnson
- Duke Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
| | - Xiling Shen
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States of America
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Romero-Morales C, Bravo-Aguilar M, Abuín-Porras V, Almazán-Polo J, Calvo-Lobo C, Martínez-Jiménez EM, López-López D, Navarro-Flores E. Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Dis Mon 2021; 67:101210. [PMID: 34099238 DOI: 10.1016/j.disamonth.2021.101210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - María Bravo-Aguilar
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Eva María Martínez-Jiménez
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | - Emmanuel Navarro-Flores
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain.
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Abstract
PURPOSE OF REVIEW The number of applications for peripheral nerve stimulation (PNS) in the pain management field is ever-growing. With the increasing number of clinical applications for peripheral nerve stimulation, the purpose of this article is to review the mechanism of action surrounding PNS, the recent literature from January 2018 to January 2021, and pertinent clinical outcomes. RECENT FINDINGS The authors searched articles identified from PubMed (January 2018-January 2021), Cochrane Central Register of Controlled Trials databases (January 2018-January 2021), and Scopus (January 2018-January 2021) databases, and manually searched references of identified publications. Broad MeSH terms and Boolean operators were queried in each search, including the following terms and their respective synonyms: peripheral nerve stimulation, mechanism of action, biochemical pathway, and pain pathway. 15 consensus articles were selected for in-depth review and inclusion for qualitative analysis. PNS may activate and modulate higher central nervous system (CNS) centers, including the dorsal lateral prefrontal cortex, somatosensory cortex, anterior cingulate cortex, and parahippocampal areas. Neuromodulatory effects from PNS may also extend into the spinal columns. Also, PNS may lead to changes in endogenous neurotransmitters and affect the plasticity of NMDA pathways.
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Percutaneous Electrical Nerve Stimulation (PENS) as a Rehabilitation Approach for Reducing Mixed Chronic Pain in Patients with Musculoskeletal Disorders. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11094257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
“Mixed pain” is a term recently introduced to define the overlapping of nociceptive, neuropathic and nociplastic pain. To date, it has been reported that pharmacological treatments might have a modest effectiveness on patients affected by mixed chronic pain, with detrimental consequences in terms of disability, physical function and health-related quality of life. In this scenario, Percutaneous Electrical Nerve Stimulation (PENS), a mini-invasive neuromodulation technique, has been recently suggested as a promising approach for the complex management of mixed pain in musculoskeletal disorders. Albeit PENS showed to be effective in reducing unspecified pain in several chronic pain conditions, there is still a lack of evidence in the literature about its role in the management of neuropathic or mixed pain not responsive to pharmacological treatments. Therefore, by the present scoping review, we portray the potential effects of PENS in the multidisciplinary and multidimensional management of mixed chronic pain in patients with musculoskeletal disorders.
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Camargo Cárdenas FJ, Valencia Cataño A, Vargas JF. Anesthetic considerations in patients with implantable devices and chronic pain surgery. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The use of advanced invasive techniques for the control of chronic pain in patients with multiple comorbidities is becoming increasingly common. Neuromodulation offers a new management alternative involving the infusion of one or more drugs into the epidural or intrathecal space through a fully implantable infusion pump. It also involves spinal stimulation, a minimally invasive technique in which electrodes are positioned in the epidural space and connected to a pulse generator that is implanted subcutaneously and generates pulses designed to suppress the noxious stimulus. This article will describe the anesthetic considerations in cases of implantable drug delivery systems, and spinal and peripheral nerve stimulation devices. Additionally, patients with electrical or drug neuromodulation devices may present to anesthetic practice for surgical indications unrelated to their chronic pain pathology. Hence the importance of being familiar with the basic components of these devices, how they work, what drugs they use and the potential associated complications in the perioperative context, in order to ensure proper management and patient safety.
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Regnier SM, Chen J, Gabriel RA, Chakravarthy KV. A review of the StimRouter® peripheral neuromodulation system for chronic pain management. Pain Manag 2021; 11:227-236. [DOI: 10.2217/pmt-2020-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The StimRouter® peripheral nerve stimulation system created by Bioness, Inc., (CA, USA) is US FDA-approved for the treatment of peripheral mononeuropathy refractory to conservative medical management. StimRouter is a minimally invasive system that utilizes a subcutaneously implanted lead with integrated anchor and electrodes, and an external pulse generator to produce peripheral neuromodulation and achieve pain relief. Multiple published clinical trials reviewed here have shown the StimRouter system to have a high margin of safety, differentiating it from other existing peripheral neuromodulation systems requiring open surgical electrode placement and implantable pulse generators. These studies have also shown the StimRouter system to be efficacious in the treatment of multiple peripheral mononeuropathies; improving patient pain, activity levels and quality of life. StimRouter represents a feasible option for management of chronic peripheral mononeuropathy.
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Affiliation(s)
- Shane M Regnier
- Department of Anesthesiology & Pain Medicine, University of California San Diego, San Diego, CA 92037, USA
| | - Jeffrey Chen
- Department of Anesthesiology & Pain Medicine, University of California San Diego, San Diego, CA 92037, USA
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Rodney A Gabriel
- Department of Anesthesiology & Pain Medicine, University of California San Diego, San Diego, CA 92037, USA
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, San Diego, CA 92037, USA
| | - Krishnan V Chakravarthy
- Department of Anesthesiology & Pain Medicine, University of California San Diego, San Diego, CA 92037, USA
- Department of Anesthesiology, VA San Diego Healthcare System, San Diego, CA 92161, USA
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Deer TR, Eldabe S, Falowski SM, Huntoon MA, Staats PS, Cassar IR, Crosby ND, Boggs JW. Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain with Percutaneous Peripheral Nerve Stimulation. J Pain Res 2021; 14:721-736. [PMID: 33737830 PMCID: PMC7966353 DOI: 10.2147/jpr.s297091] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/23/2022] Open
Abstract
Peripheral nerve stimulation (PNS) is an effective tool for the treatment of chronic pain, although its efficacy and utilization have previously been significantly limited by technology. In recent years, purpose-built percutaneous PNS devices have been developed to overcome the limitations of conventional permanently implanted neurostimulation devices. Recent clinical evidence suggests clinically significant and sustained reductions in pain can persist well beyond the PNS treatment period, outcomes that have not previously been observed with conventional permanently implanted neurostimulation devices. This narrative review summarizes mechanistic processes that contribute to chronic pain, and the potential mechanisms by which selective large diameter afferent fiber activation may reverse these changes to induce a prolonged reduction in pain. The interplay of these mechanisms, supported by data in chronic pain states that have been effectively treated with percutaneous PNS, will also be discussed in support of a new theory of pain management in neuromodulation: Peripherally Induced Reconditioning of the Central Nervous System (CNS).
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Steven M Falowski
- Department of Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Marc A Huntoon
- Anesthesiology, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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Asimakidou E, Matis GK. Spinal cord stimulation in the treatment of peripheral vascular disease: a systematic review - revival of a promising therapeutic option? Br J Neurosurg 2021; 36:555-563. [PMID: 33703962 DOI: 10.1080/02688697.2021.1884189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Peripheral vascular disease (PVD) is caused by a blood circulation disorder of the arteries and Critical Limb Ischemia (CLI) is the advanced state of PVD. For patients with surgically non-reconstructable CLI, Spinal Cord Stimulation (SCS) appears to be an alternative therapeutic option. OBJECTIVE The aim of our study was to investigate the efficacy of SCS in non-reconstructable CLI compared with the conservative treatment and re-appraise the existing literature in light of the recent advances in neuromodulation. METHODS We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using electronic databases and reference lists for article retrieval. RESULTS A total of 404 records were identified and finally 6 randomised controlled trials (RCTs), a Cochrane review and a meta-analysis were included in our systematic review. The studies assessed the efficacy of tonic SCS in the treatment of patients with non-reconstructable CLI compared with the conservative treatment. There is moderate to high quality evidence suggesting, that tonic SCS has beneficial effects for patients suffering from non-reconstructable CLI in terms of limb salvage, pain relief, clinical improvement and quality of life. The contradictory conclusions of the two meta-analyses regarding the efficacy of SCS for limb salvage at 12 months refer rather to the magnitude of the beneficial effect than to the effect itself. So far, the current literature provides evidence about the traditional tonic SCS but there is a lack of studies investigating the efficacy of new waveforms in the treatment of non-reconstructable CLI. CONCLUSION SCS represents an alternative for PVD patients with non-reconstructable CLI and the existing literature provides encouraging clinical results, that should not be neglected. Instead, they should be re-appraised in light of the recent advances in neuromodulation with the emergence of novel waveform technologies and neuromodulation targets.
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Affiliation(s)
- Evridiki Asimakidou
- Department of Stereotactic and Functional Neurosurgery, University Cologne Hospital, Cologne, Germany
| | - Georgios K Matis
- Department of Stereotactic and Functional Neurosurgery, University Cologne Hospital, Cologne, Germany
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41
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Collins MN, Legon W, Mesce KA. The Inhibitory Thermal Effects of Focused Ultrasound on an Identified, Single Motoneuron. eNeuro 2021; 8:ENEURO.0514-20.2021. [PMID: 33853851 PMCID: PMC8174046 DOI: 10.1523/eneuro.0514-20.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/18/2021] [Accepted: 03/28/2021] [Indexed: 12/30/2022] Open
Abstract
Focused ultrasound (US) is an emerging neuromodulation technology that has gained much attention because of its ability to modulate, noninvasively, neuronal activity in a variety of animals, including humans. However, there has been considerable debate about exactly which types of neurons can be influenced and what underlying mechanisms are in play. Are US-evoked motor changes driven indirectly by activated mechanosensory inputs, or more directly via central interneurons or motoneurons? Although it has been shown that US can mechanically depolarize mechanosensory neurons, there are no studies that have yet tested how identified motoneurons respond directly to US and what the underlying mechanism might be. Here, we examined the effects of US on a single, identified motoneuron within a well-studied and tractable invertebrate preparation, the medicinal leech, Hirudo verbana Our approach aimed to clarify single neuronal responses to US, which may be obscured in other studies whereby US is applied across a diverse population of cells. We found that US has the ability to inhibit tonic spiking activity through a predominately thermal mechanism. US-evoked effects persisted after blocking synaptic inputs, indicating that its actions were direct. Experiments also revealed that US-comparable heating blocked the axonal conduction of spontaneous action potentials. Finally, we found no evidence that US had significant mechanical effects on the neurons tested, a finding counter to prevailing views. We conclude that a non-sensory neuron can be directly inhibited via a thermal mechanism, a finding that holds promise for clinical neuromodulatory applications.
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Affiliation(s)
- Morgan N Collins
- Graduate Program in Neuroscience, University of Minnesota, St. Paul, MN 55108
| | - Wynn Legon
- Department of Neurological Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22901
| | - Karen A Mesce
- Graduate Program in Neuroscience, University of Minnesota, St. Paul, MN 55108
- Departments of Entomology and Neuroscience, University of Minnesota, St. Paul, MN 55108
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Ferreira-Dos-Santos G, Hurdle MFB, Gupta S, Ghazi SM, Trigg SD, Clendenen SR. Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Intractable Pain Originating From a Lipofibromatous Hamartoma of the Median Nerve. J Hand Surg Am 2021; 46:250.e1-250.e5. [PMID: 32698979 DOI: 10.1016/j.jhsa.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
This case report presents an application of peripheral nerve stimulation to the median nerve to treat a patient with intractable pain due to a lipofibromatous hamartoma of the left upper extremity. Ultra high-frequency ultrasound was used to determine the boundaries of the hamartoma. The patient then underwent an ultrasound-guided implantation of 2 stimulator electrodes distal to the elbow along the median nerve with stimulation coverage achieved at 1.2 and 1.4 mA, respectively. After an uneventful procedure, the pain score immediately decreased from 9 out of 10 to less than 6 on a numeric rating scale. Two weeks after the procedure, the patient reported substantial pain relief, with an average pain level of 5 to 6 out of 10. Twelve months after implantation, the patient maintained significant pain relief, rating her average pain level as a 4 to 6 out of 10. Placement of a percutaneous peripheral nerve stimulator was safe and effective with no adverse events being reported at the 12-month follow-up.
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Affiliation(s)
- Guilherme Ferreira-Dos-Santos
- Department of Physical Medicine and Rehabilitation, Central Lisbon University Hospital Center, Lisbon, Portugal; NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.
| | | | - Sahil Gupta
- Department of Pain Medicine, Southern Illinois Healthcare, Carbondale, IL
| | - Salim M Ghazi
- Department of Pain Medicine, Mayo Clinic, Jacksonville, FL
| | - Stephen D Trigg
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| | - Steven R Clendenen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
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Schwarm FP, Ott M, Nagl J, Leweke F, Stein M, Uhl E, Maxeiner H, Kolodziej MA. Preoperative Elevated Levels for Depression, Anxiety, and Subjective Mental Stress Have No Influence on Outcome Measures of Peripheral Nerve Field Stimulation for Chronic Low Back Pain-A Prospective Study. Neuromodulation 2021; 24:1042-1050. [PMID: 33522693 DOI: 10.1111/ner.13368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/16/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Peripheral nerve field stimulation (PNFS) is an effective alternative treatment for patients with chronic low back pain. The treatment of low back pain strongly depends on psychological factors like anxiety, depression, and mental stress. The aim of this study was to evaluate the impact of such factors on outcome measures after lead- and implantable pulse generator-implantation. MATERIALS AND METHODS Between 2014 and 2019, a prospective cohort study of 39 patients with chronic lumbar pain was conducted. Hospital Anxiety and Depression Scale (HADS) score was assessed at baseline to measure symptoms of anxiety and depression. Symptom checklist-90 (SCL-90) was used to measure subjective psychopathology. Pain intensity (numeric pain rating scale [NRS]), SF12v2 with Physical Component Summary and Mental Component Summary (MCS) scores, and Oswestry Disability Index (ODI) were assessed pre- and postoperatively as well as three and six months after PNFS implantation. Outcome values were compared to baseline data. Statistical analysis was performed using depending t-test and analysis of variance (ANOVA). A p value <0.05 was considered significant. RESULTS The cohort consisted of 39 patients (18 females, 21 males) with a median age of 61 years (IQR25-75 = 52-67 years). NRS, ODI, and SF12v2 showed significant improvement in the whole follow-up period compared to baseline values (p < 0.05). Elevated HADS scores for anxiety were seen in 64.1%, for depression in 76.9% of the patients at baseline. SCL-90 was pathologic in 71.8% of the cases. A one-way ANOVA revealed no differences between elevated HADS- and SCL-90 values and all outcome measures after PNFS implantation in the whole follow-up period (p > 0.05). CONCLUSION Chronic low back pain is often associated with psychological distress. Our study showed highly elevated levels for anxiety and depression as well as subjective mental stress in patients with chronic low back pain without negative impact on NRS, ODI, and SF12v2 in the whole follow-up after PNFS implantation.
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Affiliation(s)
- Frank P Schwarm
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Marc Ott
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Jasmin Nagl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hagen Maxeiner
- Department of Anesthesiology, Intensive Care and Pain Therapy, Justus-Liebig-University Giessen, Giessen, Germany
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Gabriel RA, Ilfeld BM. Acute postoperative pain management with percutaneous peripheral nerve stimulation: the SPRINT neuromodulation system. Expert Rev Med Devices 2021; 18:145-150. [PMID: 33446005 DOI: 10.1080/17434440.2021.1877134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Ultrasound-guided percutaneous peripheral nerve stimulation (PNS) may be used to treat acute postoperative pain for various types of surgeries. This modality avoids several limitations of traditional local anesthetic-based peripheral nerve blocks including avoidance of motor blockade and sensory deficits. AREAS COVERED In this review, we discuss the use of SPRINT (SPR Therapeutics, Cleveland, OH) neuromodulation system in the setting of acute postoperative pain management. EXPERT OPINION PNS is a novel modality in regional anesthesia that has much promise in reducing overall opioid use after surgery. Placement of PNS is very similar to that of catheter-based regional anesthesia techniques. Ultrasound is used to guide the percutaneously placed introducer needle in proximity to the target nerve. There are several benefits of PNS over catheter-based approaches, including: 1) avoidance of motor or sensory blockade; 2) no medication bag required to be carried; and 3) electric leads may be kept in situ safely for up to 60 days. While several proof-of-concept studies have been published highlighting its use in various types of surgeries, large high-quality randomized controlled trials are still needed.
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Affiliation(s)
- Rodney A Gabriel
- Division of Regional Anesthesia and Acute Pain Medicine, Medical Director, Koman Outpatient Pavilion, Department of Anesthesiology, University of California, San Diego. United States
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California, San Diego, United States
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Schnack LL, Oexeman S, Rodriguez-Collazo ER. Implantable Neuromodulation Device in the Lower Limb: An Adjunctive Procedure in Patients with Continued Chronic Pain After Failed Revisional Microneurosurgical Procedure in a Nonreconstructable Zone of Injury. Clin Podiatr Med Surg 2021; 38:e31-e43. [PMID: 35101240 DOI: 10.1016/j.cpm.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Implantable peripheral nerve stimulators are used with the goal to decrease the neuropathic pain level and possibly the need for opioid analgesics. Peripheral nerve injuries and pathology must be thoroughly evaluated before implantation of neuromodulation devices. Ultrasound-guided nerve blocks and a peripheral nerve stimulator trial is performed before surgical implantation. In this article, the authors discuss indications, clinical and diagnostic examinations, and their surgical technique for implantation of the Bioventus StimRouter.
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Affiliation(s)
- Lauren L Schnack
- CPME Postdoctoral Fellowship Complex Deformity Correction & Limb Reconstruction, American Microsurgical Orthoplastic Society; AMITA Health - Saint Joseph Hospital Chicago, Attn: Podiatric Fellow Office Suite 425, 2913 N Commonwealth Avenue, Chicago, IL 60657, USA.
| | - Stephanie Oexeman
- AMITA Health - Saint Joseph Hospital Chicago, 2913 N Commonwealth Avenue Suite 425, Chicago, IL 60657, USA
| | - Edgardo R Rodriguez-Collazo
- CPME Postdoctoral Fellowship, Complex Deformity Correction & Limb Reconstruction, Adults & Pediatric Ilizarov Limb Deformity Correction; Peripheral Nerve Reconstructive Microsurgery; American Microsurgical Orthoplastic Society; Department of Surgery, AMITA Health - Saint Joseph Hospital Chicago, Laboure Outpatient Clinic, 2913 North Commonwealth Avenue, Chicago, IL 60657, USA
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Mainkar O, Singh H, Gargya A, Lee J, Valimahomed A, Gulati A. Ultrasound-Guided Peripheral Nerve Stimulation of Cervical, Thoracic, and Lumbar Spinal Nerves for Dermatomal Pain: A Case Series. Neuromodulation 2020; 24:1059-1066. [PMID: 33314509 DOI: 10.1111/ner.13334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES With the development of percutaneously inserted devices, peripheral nerve stimulation (PNS) has been gaining attention within chronic pain literature as a less invasive neurostimulation alternative to spinal column and dorsal root ganglion stimulation. A majority of current PNS literature focuses on targeting individual distal nerves to treat individual peripheral mononeuropathies, limiting its applications. This article discusses our experience treating dermatomal pain with neurostimulation without needing to access the epidural space by targeting the proximal spinal nerve with peripheral nerve stimulation under ultrasound-guidance. MATERIALS AND METHODS A temporary, percutaneous PNS was used to target the proximal spinal nerve in 11 patients to treat various dermatomal pain syndromes in patients seen in an outpatient chronic pain clinic. Four patients received stimulation targeting the lumbar spinal nerves and seven patient received stimulation targeting the cervical or thoracic spinal nerves. RESULTS The case series presents 11 cases of PNS of the proximal spinal nerve. Seven patients, including a majority of the patients with lumbar radiculopathy, had analgesia during PNS. Four patients, all of whom targeted the cervical or thoracic spinal nerves, did not receive analgesia from PNS. CONCLUSION PNS of the proximal spinal nerve may be an effective modality to treat dermatomal pain in patients who are not candidates for other therapies that require access to the epidural space. This technique was used to successfully treat lumbar radiculopathy, post-herpetic neuralgia, and complex regional pain syndrome.
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Affiliation(s)
- Ojas Mainkar
- New York Presbyterian/Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA
| | - Harmandeep Singh
- New York Presbyterian/Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA
| | - Akshat Gargya
- New York Presbyterian/Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA
| | - Jane Lee
- New York Presbyterian/Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA
| | - Ali Valimahomed
- Advanced Orthopedics and Sports Medicine Institute, Freehold, NJ, USA
| | - Amitabh Gulati
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology, New York, NY, USA
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Warner NS, Schaefer KK, Eldrige JS, Lamer TJ, Pingree MJ, Bendel MA, Warner MA, Rho RH, Mauck WD. Peripheral Nerve Stimulation and Clinical Outcomes: A Retrospective Case Series. Pain Pract 2020; 21:411-418. [PMID: 33222402 DOI: 10.1111/papr.12968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/11/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Peripheral nerve stimulation (PNS) is a rapidly expanding field within neuromodulation; however, there is limited data on therapeutic efficacy. This study describes the indications and clinical outcomes for patients undergoing PNS for chronic pain states. PATIENTS AND METHODS This is a retrospective case series of adults undergoing PNS implantation from 2004 to 2017 at an academic medical center. The primary outcomes were changes in numeric rating scale (NRS) pain scores, opioid utilization in oral morphine milligram equivalent (MME), and self-reported patient functioning at 6 months postoperatively. Infectious and device-related complications were also assessed. RESULTS A total of 72 patients underwent PNS implantation, including 59 patients that received a preceding PNS trial (59/78; 76% progression rate) and 13 that did not receive a PNS trial. The most common indication for stimulation was occipital neuralgia (47%) followed by lower-extremity neuropathies (17%). PNS implantation was associated with 6-month reductions in pain scores (7 [6, 8] baseline vs. 4 [2, 5] 6 months; P < 0.001) and opioid utilization (eg, median 60 [31, 104] vs. 18 [0, 52] MME among those with baseline opioid use; P < 0.001). Median functional improvement was 73% (50%, 88%). Seven patients (10%) suffered a postoperative surgical site infection at a median of 50 (30, 124) days, of which five devices were removed. CONCLUSION Peripheral nerve stimulation was associated with reduced pain scores, lower opioid utilization, and improved patient function at 6 months. These data support PNS as a potentially effective nonopioid analgesic modality in chronic pain, though prospective multicenter evaluation is warranted to evaluate longer-term outcomes.
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Affiliation(s)
- Nafisseh S Warner
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kalli K Schaefer
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jason S Eldrige
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew J Pingree
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Markus A Bendel
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew A Warner
- Division of Critical Care, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Richard H Rho
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - William D Mauck
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
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Kosta P, Mize J, Warren DJ, Lazzi G. Simulation-Based Optimization of Figure-of-Eight Coil Designs and Orientations for Magnetic Stimulation of Peripheral Nerve. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2901-2913. [PMID: 33201821 DOI: 10.1109/tnsre.2020.3038406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although magnetic neural stimulation has many advantages over electrical neural stimulation, its main disadvantages are higher energy requirement and poor stimulation selectivity. The orientation and location of the coil with respect to the stimulation site play a critical role in determining the stimulation threshold and stimulation selectivity. Utilizing numerical simulations in this work, we optimized the design parameters, orientation, and positioning of magnetic coils with respect to the peripheral nerve for improved stimulation efficacy. Specifically, we investigated different orientations and positions of the figure-of-eight coils for neural stimulation of the rat sciatic nerve. We also examined the effect of coil design parameters (number of layers and turns) and different coil electrical configurations (opposite vs. same direction of coil currents and series vs. parallel coil connections) on the stimulation threshold. We leveraged the multi-resolution impedance method and a heterogeneous multi-fascicular anatomical model of rat sciatic nerve to explore the possibility of selective stimulation as well. Neural excitation of a nerve fiber was implemented by an equivalent cable model and Frankenhaeuser-Huxley equations using NEURON software. Results suggest that inter-fascicular selectivity could be achieved by properly orienting and positioning the coil with respect to the nerve. Further, by orienting the figure-of-eight coil at an angle of 90° and 6 mm offset, we could switch between primarily activating one fascicle (and barely activating the other) and reversing those roles by merely switching the current direction in the two coils of the figure-of-eight coil.
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García-Magro N, Negredo P, Martin YB, Nuñez Á, Avendaño C. Modulation of mechanosensory vibrissal responses in the trigeminocervical complex by stimulation of the greater occipital nerve in a rat model of trigeminal neuropathic pain. J Headache Pain 2020; 21:96. [PMID: 32762640 PMCID: PMC7410158 DOI: 10.1186/s10194-020-01161-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background Stimulation of the occipital or trigeminal nerves has been successfully used to treat chronic refractory neurovascular headaches such as migraine or cluster headache, and painful neuropathies. Convergence of trigeminal and occipital sensory afferents in the ‘trigeminocervical complex’ (TCC) from cutaneous, muscular, dural, and visceral sources is a key mechanism for the input-induced central sensitization that may underlie the altered nociception. Both excitatory (glutamatergic) and inhibitory (GABAergic and glycinergic) mechanisms are involved in modulating nociception in the spinal and medullary dorsal horn neurons, but the mechanisms by which nerve stimulation effects occur are unclear. This study was aimed at investigating the acute effects of electrical stimulation of the greater occipital nerve (GON) on the responses of neurons in the TCC to the mechanical stimulation of the vibrissal pad. Methods Adult male Wistar rats were used. Neuronal recordings were obtained in laminae II-IV in the TCC in control, sham and infraorbital chronic constriction injury (CCI-IoN) animals. The GON was isolated and electrically stimulated. Responses to the stimulation of vibrissae by brief air pulses were analyzed before and after GON stimulation. In order to understand the role of the neurotransmitters involved, specific receptor blockers of NMDA (AP-5), GABAA (bicuculline, Bic) and Glycine (strychnine, Str) were applied locally. Results GON stimulation produced a facilitation of the response to light facial mechanical stimuli in controls, and an inhibition in CCI-IoN cases. AP-5 reduced responses to GON and vibrissal stimulation and blocked the facilitation of GON on vibrissal responses found in controls. The application of Bic or Str significantly reduced the facilitatory effect of GON stimulation on the response to vibrissal stimulation in controls. However, the opposite effect was found when GABAergic or Glycinergic transmission was prevented in CCI-IoN cases. Conclusions GON stimulation modulates the responses of TCC neurons to light mechanical input from the face in opposite directions in controls and under CCI-IoN. This modulation is mediated by GABAergic and Glycinergic mechanisms. These results will help to elucidate the neural mechanisms underlying the effectiveness of nerve stimulation in controlling painful craniofacial disorders, and may be instrumental in identifying new therapeutic targets for their prevention and treatment.
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Affiliation(s)
- Nuria García-Magro
- Department of Anatomy, Histology and Neuroscience, Medical School, Autonoma University of Madrid, c/ Arzobispo Morcillo 2, 28029, Madrid, Spain.,Programme in Neuroscience, Doctoral School, Autonoma University of Madrid, Madrid, Spain
| | - Pilar Negredo
- Department of Anatomy, Histology and Neuroscience, Medical School, Autonoma University of Madrid, c/ Arzobispo Morcillo 2, 28029, Madrid, Spain
| | - Yasmina B Martin
- Facultad de Medicina, Universidad Francisco de Vitoria, 28223, Madrid, Spain
| | - Ángel Nuñez
- Department of Anatomy, Histology and Neuroscience, Medical School, Autonoma University of Madrid, c/ Arzobispo Morcillo 2, 28029, Madrid, Spain
| | - Carlos Avendaño
- Department of Anatomy, Histology and Neuroscience, Medical School, Autonoma University of Madrid, c/ Arzobispo Morcillo 2, 28029, Madrid, Spain.
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Gupta S, Clendenen S, Ferreira-Dos-Santos G, Hurdle MF. Ultrasound-Guided Intercostal Peripheral Nerve Stimulator Implantation: Technique Report and Feasibility Study in a Cadaver. PAIN MEDICINE 2020; 21:S32-S37. [PMID: 32804225 DOI: 10.1093/pm/pnaa012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to describe and validate a novel ultrasound-guided intercostal peripheral nerve stimulator implantation technique. METHODS The fifth to tenth ribs on both sides of an unembalmed cadaveric specimen were localized using a 15-6-MHz linear array transducer, counting distally from T-1 bilaterally. A single interventionist then implanted 12 peripheral nerve stimulators on the fifth through tenth ribs, six MicroLeads on the left side and six StimRouters on the right side, using an in-plane lateral to medial approach to the inferior border of the corresponding rib. After all the stimulators were implanted, their location was confirmed using fluoroscopy. Gross anatomic dissection was later performed for each of the stimulators placed, and the distance of the lead from the intercostal nerve and pleura was noted. RESULTS All leads were noted in an accurate position in the plane between the inner and innermost intercostal muscle, without any intrapleural placement. The distance of the leads from the intercostal nerves was on average 2.3 mm and 1.1 mm for MicroLead and StimRouter, respectively. CONCLUSIONS To our knowledge, this study is the first to determine the feasibility of ultrasound-guided peripheral nerve stimulator placement in close proximity to the pleura. All the stimulator leads were accurately placed using our ultrasound-guided technique and were within 0.5-3 mm from the intercostal nerve. Although this technique might prove technically challenging, the use of ultrasound for intercostal peripheral nerve stimulator implantation appears feasible and warrants further investigation to establish this as an acceptable technique for patients.
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Affiliation(s)
- Sahil Gupta
- Department of Pain Medicine, Southern Illinois Healthcare, Carbondale, Illinois
| | - Steven Clendenen
- Department of Pain Medicine, Southern Illinois Healthcare, Carbondale, Illinois
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