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Haider N, Gargya A. Fluoroscopy-Guided Lumbar Spinal Nerve Stimulation to Treat Chronic Scrotal Pain. Cureus 2023; 15:e42298. [PMID: 37484790 PMCID: PMC10362928 DOI: 10.7759/cureus.42298] [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: 07/22/2023] [Indexed: 07/25/2023] Open
Abstract
Chronic scrotal pain (CSP) is a challenging problem for both pain physicians and urologists. Depending on the cause, treatment options may include pharmacological management, spermatic cord blocks, microsurgical denervation of the spermatic cord, botulinum toxin injections, and ultrasound-guided peripheral nerve stimulation (PNS) of ilioinguinal and iliohypogastric nerves. We describe a new target for the treatment of CSP by PNS of the L2 spinal nerve and a novel technical approach of using fluoroscopic guidance to stimulate lumbar spinal nerves, which can potentially be used for different indications.
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Affiliation(s)
- Naeem Haider
- Anesthesiology and Pain Medicine, University of Vermont Medical Center, Burlington, USA
| | - Akshat Gargya
- Anesthesiology and Pain Medicine, University of Vermont Medical Center, Burlington, USA
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Aggarwal AK, Ottestad E, Pfaff KE, Huai-Yu Li A, Xu L, Derby R, Hecht D, Hah J, Pritzlaff S, Prabhakar N, Krane E, D’Souza G, Hoydonckx Y. Review of Ultrasound-Guided Procedures in the Management of Chronic Pain. Anesthesiol Clin 2023; 41:395-470. [DOI: 10.1016/j.anclin.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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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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Wong AK, Ng AT. Review of Ilioinguinal Nerve Blocks for Ilioinguinal Neuralgia Post Hernia Surgery. Curr Pain Headache Rep 2020; 24:80. [PMID: 33331965 DOI: 10.1007/s11916-020-00913-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the current evidence on ultrasound-guided ilioinguinal nerve blocks for ilioinguinal neuralgia post hernia surgery. METHODS A literature search was performed to find all relevant case reports, case series, prospective or retrospective cohort studies, and randomized controlled trials (RCTs) where ultrasound-guided or landmark-based ilioinguinal nerve blocks were used for ilioinguinal neuralgia post-inguinal hernia surgery. RECENT FINDINGS A total of six studies were identified with suitable data for inclusion. Three studies were retrospective, two studies were prospective, and one study was a randomized controlled trial. A total of 133 subjects were enrolled across these studies. Approximately 55-70% had a beneficial analgesic response to treatment. No major complications were reported in these studies. Ultrasound- and landmark-based ilioinguinal nerve blocks are safe and effective for pain relief post inguinal hernia surgery. Although there were two studies that did not show a statically significant difference in both techniques, the ultrasound-guided injection has the advantage of direct visualization of pathology, more accurate needle placement, and decreased risks of intravascular injections.
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Affiliation(s)
- Andrew K Wong
- Department of Anesthesiology, Division of Pain Medicine, Thomas Jefferson University Hospital, 3 Crescent Drive, Philadelphia, PA, 19112, USA
| | - Andrew T Ng
- Department of Anesthesiology, Division of Pain Medicine, Thomas Jefferson University Hospital, 3 Crescent Drive, Philadelphia, PA, 19112, USA.
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Abstract
BACKGROUND Chronic, focal, neuropathic pain is difficult to treat. Local nerve blocks are either ineffective or do not last. Regular neuromodulation modalities like spinal cord stimulation (SCS) or pain pump are invasive and affect a larger area. OBJECTIVES To discuss the indications, technique, nuances, programming, and outcomes of peripheral neuromodulation. METHODS The article reviews published literature and the author's own experience of over 500 cases of peripheral neuromodulation. RESULTS AND CONCLUSION Peripheral neuromodulation using peripheral nerve field stimulation (PNFS) is an effective, minimally invasive, targeted method of treatment. It is a relatively new modality in the field of neuromodulation but is used more often.
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Affiliation(s)
- Milind Deogaonkar
- Department of Neurosurgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
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Abstract
Nerve stimulation is a reversible technique that is used successfully for the treatment of traumatic neuropathic pain, complex regional pain syndrome, and craniofacial neuropathic pain. Nerve field stimulation targets painful regions rather than a single nerve and has expanded indications, including axial low back pain. Appropriate patient education and motivation are crucial prior to surgery. Ongoing research is necessary to provide high-level evidence for the use of nerve stimulation. Most electrodes are primarily designed for spinal cord stimulation, hence the need to develop nerve electrodes dedicated for nerve stimulation.
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Affiliation(s)
- Mark Corriveau
- Department of Neurosurgery, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Wendell Lake
- Department of Neurosurgery, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Amgad Hanna
- Department of Neurosurgery, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA.
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Roy H, Offiah I, Dua A. Neuromodulation for Pelvic and Urogenital Pain. Brain Sci 2018; 8:brainsci8100180. [PMID: 30274287 PMCID: PMC6209873 DOI: 10.3390/brainsci8100180] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
Chronic pain affecting the pelvic and urogenital area is a major clinical problem with heterogeneous etiology, affecting both male and female patients and severely compromising quality of life. In cases where pharmacotherapy is ineffective, neuromodulation is proving to be a potential avenue to enhance analgesic outcomes. However, clinicians who frequently see patients with pelvic pain are not traditionally trained in a range of neuromodulation techniques. The aim of this overview is to describe major types of pelvic and urogenital pain syndromes and the neuromodulation approaches that have been trialed, including peripheral nerve stimulation, dorsal root ganglion stimulation, spinal cord stimulation, and brain stimulation techniques. Our conclusion is that neuromodulation, particularly of the peripheral nerves, may provide benefits for patients with pelvic pain. However, larger prospective randomized studies with carefully selected patient groups are required to establish efficacy and determine which patients are likely to achieve the best outcomes.
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Affiliation(s)
- Holly Roy
- Neurosurgery Department, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| | - Ifeoma Offiah
- Department of Obstetrics and Gynaecology, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| | - Anu Dua
- Department of Obstetrics and Gynaecology, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
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Baciarello M, Migliavacca G, Marchesini M, Valente A, Allegri M, Fanelli G. Transversus Abdominis Plane Block for the Diagnosis and Treatment of Chronic Abdominal Wall Pain Following Surgery: A Case Series. Pain Pract 2017; 18:109-117. [DOI: 10.1111/papr.12570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/28/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Marco Baciarello
- Anesthesiology, Critical Care and Pain Medicine Division; Department of Medicine and Surgery; University of Parma; Parma Italy
- Study in Multidisciplinary Pain Research (SIMPAR) Group; Parma Italy
| | - Greta Migliavacca
- Anesthesiology, Critical Care and Pain Medicine Division; Department of Medicine and Surgery; University of Parma; Parma Italy
| | - Maurizio Marchesini
- Study in Multidisciplinary Pain Research (SIMPAR) Group; Parma Italy
- Second Unit of Anesthesia, Critical Care and Pain Medicine; University Hospital of Parma; Parma Italy
| | - Adriana Valente
- Anesthesiology, Critical Care and Pain Medicine Division; Department of Medicine and Surgery; University of Parma; Parma Italy
| | - Massimo Allegri
- Anesthesiology, Critical Care and Pain Medicine Division; Department of Medicine and Surgery; University of Parma; Parma Italy
- Study in Multidisciplinary Pain Research (SIMPAR) Group; Parma Italy
| | - Guido Fanelli
- Anesthesiology, Critical Care and Pain Medicine Division; Department of Medicine and Surgery; University of Parma; Parma Italy
- Study in Multidisciplinary Pain Research (SIMPAR) Group; Parma Italy
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Shaw A, Sharma M, Zibly Z, Ikeda D, Deogaonkar M. Sandwich technique, peripheral nerve stimulation, peripheral field stimulation and hybrid stimulation for inguinal region and genital pain. Br J Neurosurg 2016; 30:631-636. [PMID: 27347767 DOI: 10.1080/02688697.2016.1199777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Ilioinguinal neuralgia (IG) and genitofemoral (GF) neuralgia following inguinal hernia repair is a chronic and debilitating neuropathic condition. Recently, peripheral nerve stimulation has become an effective and minimally invasive option for the treatment of refractory pain. Here we present a retrospective case series of six patients who underwent placement of peripheral nerve stimulation electrodes using various techniques for treatment of refractory post-intervention inguinal region pain. METHODS Six patients with post-intervention inguinal, femoral or GF neuropathic pain were evaluated for surgery. Either octopolar percutaneous electrodes or combination of paddle and percutaneous electrodes were implanted in the area of their pain. Pain visual analog scores (VAS), surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of satisfaction with this therapy was assessed. RESULTS All six patients had an average improvement of 62% in the immediate post-operative follow-up. Four patients underwent stimulation for IG, one for femoral neuralgia, and another for GF neuralgia. Peripheral nerve stimulation provided at least 50% pain relief in all the six patients with post-intervention inguinal region pain. 85% of patients indicated they were completely satisfied with the therapy overall. There was one treatment failure with an acceptable complication rate. CONCLUSION Peripheral nerve or field stimulation for post-intervention inguinal region pain is a safe and effective treatment for this refractory and complex problem for patients who have exhausted other management options.
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Affiliation(s)
- Andrew Shaw
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| | - Mayur Sharma
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| | - Zion Zibly
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| | - Daniel Ikeda
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| | - Milind Deogaonkar
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
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Liem L, Mekhail N. Management of Postherniorrhaphy Chronic Neuropathic Groin Pain: A Role for Dorsal Root Ganglion Stimulation. Pain Pract 2016; 16:915-23. [PMID: 26914499 DOI: 10.1111/papr.12424] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/29/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022]
Abstract
Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high rates, causing widespread impacts on quality of life. Although the medical community is beginning to recognize the role of surgical technique in the initiation and maintenance of postherniorrhaphy neuropathic pain, little information exists regarding pain management strategies for this condition. This review presents a summary of the pain condition state, its treatment options, and treatment recommendations. Both literature review and clinical experience were used to develop a proposed a treatment algorithm for the treatment of postherniorrhaphy pain. The development of chronic pain may be prevented via a number of perioperative measures. For pain that is already established, some surgical approaches including inguinal neurectomy can be effective, in addition to standard pharmacological treatments and local infiltrations. An unmet need may still exist with these options, however, leaving a role for neuromodulation for the treatment of intractable cases. A pain management algorithm for iterative interventions including stimulation of the dorsal root ganglion (DRG) is described. It is expected that cross-disciplinary awareness of surgeons for nonsurgical pain management options in the treatment of chronic neuropathic postherniorrhaphy pain will contribute to better clinical outcomes.
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Affiliation(s)
- Liong Liem
- Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Nagy Mekhail
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, U.S.A
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Voorbrood CEH, Burgmans JPJ, Van Dalen T, Breel J, Clevers GJ, Wille F, Simmermacher RKJ. An algorithm for assessment and treatment of postherniorrhaphy pain. Hernia 2015; 19:571-7. [DOI: 10.1007/s10029-015-1387-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/19/2015] [Indexed: 10/23/2022]
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Bjurstrom MF, Nicol AL, Amid PK, Chen DC. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res 2014; 7:277-90. [PMID: 24920934 PMCID: PMC4045265 DOI: 10.2147/jpr.s47005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Inguinal hernia repair is one of the most common surgeries performed worldwide. With the success of modern hernia repair techniques, recurrence rates have significantly declined, with a lower incidence than the development of chronic postherniorrhaphy inguinal pain (CPIP). The avoidance of CPIP is arguably the most important clinical outcome and has the greatest impact on patient satisfaction, health care utilization, societal cost, and quality of life. The etiology of CPIP is multifactorial, with overlapping neuropathic and nociceptive components contributing to this complex syndrome. Treatment is often challenging, and no definitive treatment algorithm exists. Multidisciplinary management of this complex problem improves outcomes, as treatment must be individualized. Current medical, pharmacologic, interventional, and surgical management strategies are reviewed.
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Affiliation(s)
| | - Andrea L Nicol
- Department of Anesthesiology, University of Kansas, Kansas City, KS, USA
| | - Parviz K Amid
- Department of Surgery, Lichtenstein Amid Hernia Clinic at UCLA, UCLA, Los Angeles, CA, USA
| | - David C Chen
- Department of Surgery, Lichtenstein Amid Hernia Clinic at UCLA, UCLA, Los Angeles, CA, USA
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Deogaonkar M, Slavin KV. Peripheral Nerve/Field Stimulation for Neuropathic Pain. Neurosurg Clin N Am 2014; 25:1-10. [DOI: 10.1016/j.nec.2013.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mironer YE, Monroe TR. Spinal-peripheral neurostimulation (SPN) for bilateral postherniorrhaphy pain: a case report. Neuromodulation 2012; 16:603-6. [PMID: 22928651 DOI: 10.1111/j.1525-1403.2012.00495.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Postherniorrhaphy pain is a not uncommon, and difficult to treat, pain condition. Success with different methods of neurostimulation has been reported in the literature in the last decade. We assess the use of a new modality of neuromodulation--spinal-peripheral neurostimulation (SPN). MATERIALS AND METHODS We report the results of treatment of a patient with bilateral, intractable postherniorrhaphy pain with SPN. RESULTS Significant reduction in pain and decrease in opioid consumption have been achieved. CONCLUSION SPN can be an effective treatment for postherniorrhaphy pain resistant to conservative management.
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Affiliation(s)
- Y Eugene Mironer
- Carolinas Center for Advanced Management of Pain, NC/SC, USA Spartanburg Neurosurgical Institute, Spartanburg, SC, USA
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