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Kaye AD, Plaisance TR, Smith SA, Ragland AR, Alfred MJ, Nguyen CG, Chami AA, Kataria S, Dufrene K, Shekoohi S, Robinson CL. Peripheral Nerve Stimulation in Postoperative Analgesia: A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01257-z. [PMID: 38642233 DOI: 10.1007/s11916-024-01257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE OF REVIEW Recent research has shown the effectiveness of peripheral nerve stimulators (PNS) in managing chronic pain conditions. Ongoing studies aim to explore its potential application in treating acute postoperative pain states. The purpose of this systematic review is to assess the role of PNS in providing relief for postoperative pain. RECENT FINDINGS Clinical studies investigating the use of peripheral nerve stimulators (PNS) for analgesia following various surgeries, such as total knee arthroplasty, anterior cruciate ligament repair, ankle arthroplasty, rotator cuff repair, hallux valgus correction, and extremity amputation, have shown promising results. Lead placement locations include the brachial plexus, sciatic, femoral, tibial, genicular, perineal, sural, radial, median, and ulnar nerves. These studies consistently report clinically significant reductions in pain scores, and some even indicate a decrease in opioid consumption following PNS for postoperative pain. PNS involves the subcutaneous placement of electrode leads to target peripheral nerve(s) followed by delivery of an electric current via an external pulse generator. While the precise mechanism is not fully understood, the theory posits that PNS modulates electrical stimulation, hindering the signaling of nociceptive pain. PNS presents itself as an alternative to opioid therapy, holding promise to address the opioid epidemic by offering a nonpharmacologic approach for both acute and chronic pain states.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
- Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Taylor R Plaisance
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Summer A Smith
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Amanda R Ragland
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Michael J Alfred
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Catherine G Nguyen
- School of Medicine, Louisiana State University Health Sciences Center at New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Azem A Chami
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Saurabh Kataria
- Department of Neurology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA
| | - Kylie Dufrene
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA.
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
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Xu Q, Zhou F, Yang D. Digital subtraction angiography-guided peripheral nerve stimulation via the foramen rotundum for refractory trigeminal postherpetic neuralgia: a case report and literature review. Front Neurol 2024; 15:1353882. [PMID: 38487331 PMCID: PMC10939014 DOI: 10.3389/fneur.2024.1353882] [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] [Received: 12/11/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Postherpetic neuralgia (PHN) is a debilitating complication of varicella-zoster virus infection. This case report presents a novel approach to treating refractory trigeminal maxillary postherpetic neuralgia using digital subtraction angiography (DSA)-guided peripheral nerve stimulation via the foramen rotundum. A 72-year-old female with severe, treatment-resistant pain underwent this intervention. The results demonstrated the disappearance of tactile allodynia, a significant reduction in oral analgesic requirements, and no observed complications or side effects during a 3-year follow-up period. This case highlights the potential effectiveness of DSA-guided peripheral nerve stimulation using a new dorsal root ganglion (DRG) stimulator as an alternative therapy for refractory trigeminal postherpetic neuralgia (TPHN).
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Affiliation(s)
- Qingbang Xu
- Department of Pain Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Fangyuan Zhou
- Department of Pain Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Dong Yang
- Department of Pain Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
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Ma J, Wan Y, Yang L, Huang D, Zhou H. Dual-neuromodulation strategy in pain management of herpes zoster ophthalmicus: retrospective cohort study and literature review. Ann Med 2023; 55:2288826. [PMID: 38048401 PMCID: PMC10836271 DOI: 10.1080/07853890.2023.2288826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 11/23/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Effective pain control of herpes zoster ophthalmicus (HZO) is not only essential to attenuate the clinical symptoms but to reduce the risk of postherpetic neuralgia development. Recently, neuromodulation therapy has been one promising option for neuropathic pain and increasingly applied in management of zoster-related pain. One key factor of neuromodulation treatment is the therapeutic site for the impaired nerves. In this study we aim to investigate one novel dual-neuromodulation strategy, targeting the level of the peripheral branch and trigeminal ganglion, in the pain management of HZO. METHODS Dual neuromodulation strategy combining short-term peripheral nerve stimulation (PNS) with pulsed radiofrequency (PRF) of trigeminal ganglion was compared with single PNS treatment for HZO-related pain. Clinical recordings of patients were retrospectively reviewed. The primary outcome was the pain severity, assessed by the visual analogue scale (VAS) before and after neuromodulation therapy. RESULTS PNS achieved significant relief of pain with or without PRF treatment before discharge, which provided enduring therapeutic effect up to 12-month follow-up. The mean reduction of VAS was 6.7 ± 1.4 in dual modulation therapy (n = 13) at last follow-up and 5.4 ± 1.5 in PNS subgroup (n = 20), respectively. Moreover, dual modulation strategy provided better control of pain compared with PNS therapy alone at each time point. CONCLUSION It is feasible and effective to combine the PNS and PRF in pain management of HZO. This novel dual modulation strategy of trigeminal pathway may provide additional therapeutic effects of pain symptoms in HZO population.
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Affiliation(s)
- Jiahui Ma
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Yaling Wan
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Liuqing Yang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
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Xu M, Liu J, Zhang H, Li R, Wei J. Trigeminal Ganglion Electrical Stimulation for Trigeminal Nerve Postherpetic Neuralgia: A Retrospective Study. J Pain Res 2023; 16:3633-3641. [PMID: 37928063 PMCID: PMC10625399 DOI: 10.2147/jpr.s432842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose To investigate the clinical outcome of trigeminal ganglion electrical stimulation for the treatment of trigeminal postherpetic neuralgia (TPHN). Patients and Methods A retrospective analysis of clinical data was performed on six patients who suffered from severe postherpetic neuralgia involving the trigeminal nerve maxillary and mandibular branch. They were admitted under the Pain Management Department of the First Hospital of Shanxi Medical University from July 2022 to February 2023 and underwent trigeminal ganglion electrical stimulation therapy. Visual analogue scale (VAS) scores, pregabalin dosage, pittsburgh sleep quality index (PSQI), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were recorded before treatment, as well as after treatment at 1, 4, 8, 12, and 24-week. Adverse reactions related to the treatment were also documented. Results After trigeminal ganglion electrical stimulation therapy, the VAS scores, PSQI scores, anxiety scores, depression scores, and pregabalin dosage of six patients showed significant reductions at 1, 4, 8, 12, and 24 weeks. (P < 0.05). No serious adverse reactions occurred in any of the patients. Conclusion Trigeminal ganglion electrical stimulation effectively relieved postherpetic neuralgia in the distribution areas of the trigeminal nerve 2 and 3 branches, reduced the dosage of analgesics, improved the quality of sleep, and alleviated anxiety and depression symptoms in patients. Our data suggested that It was a safe and effective clinical.
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Affiliation(s)
- Mengzhen Xu
- School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jin Liu
- School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Hui Zhang
- Department of Pain Management, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Ruiting Li
- Department of Pain Management, Taiyuan Central Hospital, Taiyuan, People’s Republic of China
| | - Junni Wei
- School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
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Foerster Z, Kleinmann B, Schlueter N, Vach K, Wolter T. Multimodal pain therapy for persistent idiopathic facial pain - a pilot study. Biopsychosoc Med 2022; 16:25. [PMID: 36494736 PMCID: PMC9733036 DOI: 10.1186/s13030-022-00254-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Persistent Idiopathic Facial Pain (PIFP) is a pain syndrome with missing evidence-based therapy recommendations. According to the biopsychosocial pain model, multidisciplinary pain treatment (MPT) offers a promising therapeutic option for chronic pain syndromes. MPT is an interprofessional treatment procedure, consisting of medical, physiotherapeutic and psychotherapeutic treatment units, which has not yet been studied in PIFP. METHODS This retrospective study included 25 patients with PIFP, who had been treated with MPT. Pain intensity on the numerical rating scale (NRS), perceived disability, habitual well-being, as well as anxiety/depression and stress scales were recorded. Moreover, the patients evaluated the efficacy of each type of the single therapeutic interventions. RESULTS There was a highly significant decrease in the characteristic pain intensity. Also habitual well-being improved significantly, as did anxiety and depression. The perceived disability and stress also improved, but without statistical significance. Physiotherapy was rated as the most effective therapeutic unit. Among the medical measures, consultations took first place (40% of the participants). Nearly three-fourths of the patients (72%) would recommend MPT. CONCLUSION The present study shows beneficial outcomes in patients with PIFP following MPT. Patients evaluate physiotherapeutic treatment as particularly efficacious. Therefore, MPT can be considered as a therapeutic option in patients with PIFP.
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Affiliation(s)
- Zita Foerster
- grid.5963.9Interdisciplinary Pain Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str, 10779106 Freiburg, Germany
| | - Barbara Kleinmann
- grid.5963.9Interdisciplinary Pain Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str, 10779106 Freiburg, Germany
| | - Nadine Schlueter
- grid.5963.9Division for Cariology, Department for operative Dentistry and Periodontology, Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str, 10779106 Freiburg, Germany ,grid.10423.340000 0000 9529 9877Department of Operative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover, Germany
| | - Kirstin Vach
- grid.5963.9Institute of Medical Biometry and Statistics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str, 10779106 Freiburg, Germany
| | - Tilman Wolter
- grid.5963.9Interdisciplinary Pain Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str, 10779106 Freiburg, Germany
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Sarica C, Iorio-Morin C, Aguirre-Padilla DH, Paff M, Villeneuve SA, Vetkas A, Yamamoto K, Samuel N, Milano V, Loh A, Santyr B, Zemmar A, Lozano AM, Hodaie M. Clinical outcomes and complications of peripheral nerve field stimulation in the management of refractory trigeminal pain: a systematic review and meta-analysis. J Neurosurg 2022; 137:1387-1395. [PMID: 35180702 DOI: 10.3171/2021.12.jns212869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Peripheral nerve field stimulation (PNFS) is a tool in the armamentarium of treatment options for trigeminal pain. The efficacy of this modality in mitigating trigeminal pain remains unclear. The aim of this study was to examine the existing literature on PNFS and elucidate pain score outcomes associated with its use in patients with trigeminal pain. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA framework. The PubMed, Web of Science, and Scopus databases were queried on June 10, 2020. Studies reporting pain outcomes in more than 5 adult patients treated with PNFS for facial pain were included. The primary outcome of the study was the mean difference in the visual analog scale (VAS) score from the last follow-up to baseline, and it was analyzed by an inverse-variance, random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale and a funnel plot. RESULTS Of the 4597 studies screened for inclusion, 46 relevant full-text articles were assessed for eligibility. Eleven observational cohort studies from the 46 articles were found to be eligible, and reported on a total of 109 patients. In 86% (94/109) of cases, trial stimulation was successful and followed by a permanent system implantation. VAS scores improved by 75% (mean difference 6.32/10 points, 95% CI 5.38-7.27 points) compared to baseline. Seventy-six percent (42/55) of patients became medication free or required lower doses of medications. The complication rate necessitating surgical revision was estimated at 32% per procedure. CONCLUSIONS These findings support the belief that PNFS provides effective, long-term pain control for trigeminal pain. Statistical heterogeneity was considerable across all studies. Future work should be aimed at conducting double-blind randomized controlled trials to determine the utility of PNFS for treating various forms of trigeminal pain for which limited therapeutic options exist.
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Affiliation(s)
- Can Sarica
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christian Iorio-Morin
- 2Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Quebec, Canada
| | | | - Michelle Paff
- 4Department of Neurosurgery, University of California, Irvine, Orange, California
| | | | - Artur Vetkas
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 5Department of Neurosurgery, Tartu University Hospital, University of Tartu, Estonia
| | - Kazuaki Yamamoto
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Nardin Samuel
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Vanessa Milano
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Aaron Loh
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Brendan Santyr
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Ajmal Zemmar
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 6Department of Neurosurgery, Henan University School of Medicine, Zhengzhou, China
- 7Department of Neurosurgery, University of Louisville, Kentucky; and
| | - Andres M Lozano
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 8Krembil Research Institute, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 8Krembil Research Institute, Toronto, Ontario, Canada
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Wong CH, Chan TCW, Wong SSC, Russo M, Cheung CW. Efficacy of Peripheral Nerve Field Stimulation for the Management of Chronic Low Back Pain and Persistent Spinal Pain Syndrome: A Narrative Review. Neuromodulation 2022; 26:538-551. [PMID: 36058792 DOI: 10.1016/j.neurom.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Various approaches have been developed with a view to treating the back pain component in patients with chronic low back pain (CLBP) and persistent spinal pain syndrome (PSPS). Emerging evidence shows that peripheral nerve field stimulation (PNFS) may be an efficacious therapeutic modality against axial low back pain. Hence, the aim of the review was to evaluate the analgesic efficacy and safety of PNFS, when used alone or as an adjunct to spinal cord stimulation (SCS), for managing CLBP and PSPS. MATERIALS AND METHODS A comprehensive search for clinical studies on PNFS and PNFS + SCS used for the management of CLBP and/or PSPS was performed using PubMed, EMBASE, MEDLINE via Proquest, and Web of Science. RESULTS A total of 15 studies were included, of which four were randomized controlled trials (RCTs), nine were observational studies, and two were case series. For patients receiving PNFS, a significant decrease in back pain intensity and analgesic consumption, together with a significant improvement in physical functioning, was observed upon implant of the permanent system. Meanwhile, the addition of PNFS to SCS in refractory cases was associated with a significant reduction in back and leg pain, respectively. CONCLUSIONS This review suggests that PNFS, when used alone or in combination with SCS, appears to be effective in managing back pain. However, high-quality evidence that supports the long-term analgesic efficacy and safety is still lacking. Hence, RCTs with a larger patient population and of a longer follow-up duration are warranted.
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Penn MC, Choi W, Brasfield K, Wu K, Briggs RG, Dallapiazza R, Russin JJ, Giannotta SL, Lee DJ. A Review of Medical and Surgical Options for the Treatment of Facial Pain. Otolaryngol Clin North Am 2022; 55:607-632. [PMID: 35490039 DOI: 10.1016/j.otc.2022.03.001] [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: 10/18/2022]
Abstract
Facial pain is a common medical complaint that is easily misdiagnosed. As a result, this pain often goes mistreated. Despite this, there are a variety of pharmacologic, surgical, and neuromodulatory options for the treatment of facial pain. In this review, the authors detail the forms of facial pain and their treatment options. They discuss the common medications used in the first-line treatment of facial pain and the second-line surgical and neuromodulatory options available to patients when pharmacologic options fail.
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Affiliation(s)
- Marisa C Penn
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wooseong Choi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kaevon Brasfield
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kevin Wu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Robert G Briggs
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Robert Dallapiazza
- Department of Neurological Surgery, Tulane School of Medicine, Tulane University, New Orleans, LA, USA
| | - Jonathan J Russin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steven L Giannotta
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Darrin J Lee
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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McCaffrey MH, Boesel TW, Di Ieva A. Anchoring of a mental nerve stimulator for treatment of facial neuropathic pain: a case illustration. Br J Neurosurg 2022:1-3. [PMID: 35445610 DOI: 10.1080/02688697.2022.2064428] [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: 09/26/2021] [Revised: 03/05/2022] [Accepted: 04/06/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Mental nerve stimulation is recognised as a treatment option for neuropathic facial pain. Historically however, lead migration across the mobile temporomandibular joint has prevented this procedures utility. METHODS We describe a new method of insertion and anchoring of a mental nerve stimulator for the management of refractory neuropathic pain in the distribution of the mental nerve. We anchored the stimulator lead to the mandibular body. RESULTS Significant analgesic effect was achieved and no lead migration had occurred at 1 year post-operatively. CONCLUSIONS This report describes in detail the procedure of mental nerve stimulator insertion, with a novel technique of mandibular anchoring of the lead.
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Affiliation(s)
| | | | - Antonio Di Ieva
- Macquarie Medical School, Macquarie University, Sydney, Australia
- Computational NeuroSurgery (CNS) Lab, Macquarie University, Sydney, Australia
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Gupta K. Case Report: Novel Anchoring Technique and Surgical Nuances for Trigeminal Ganglion Stimulation in the Treatment of Post-Herpetic Trigeminal Neuropathic Facial Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:835471. [PMID: 35369537 PMCID: PMC8967959 DOI: 10.3389/fpain.2022.835471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionTrigeminal ganglion stimulation is a neuromodulatory surgical procedure utilized to treat trigeminal neuropathic pain. This technique involves the placement of a stimulating electrode adjacent to the trigeminal ganglion and can be trialed before permanent implantation. Wider adoption by surgical practitioners is currently limited by complications such as lead migration from the trigeminal ganglion, which can result in loss of therapy and cannot be rectified without repeat surgery. We describe a novel surgical modification that successfully anchors the trigeminal ganglion electrode long-term.ObjectiveTo describe a novel surgical technique for the anchoring of trigeminal ganglion stimulation electrodes and a case report of a patient with post-herpetic trigeminal neuropathic pain treated with this approach.MethodsAn electrode was inserted percutaneously through the foramen ovale into Meckel's cave, adjacent to the trigeminal ganglion. The lead was anchored using a modification of an existing anchoring device, which was inserted into the buccal incision. The lead was connected to a generator for therapeutic stimulation. The location of the lead was followed radiographically using serial lateral skull radiographs.ResultsA 74-year-old male with post-herpetic trigeminal neuropathic pain, who had failed prior surgical therapies, underwent trigeminal ganglion stimulation. The trial lead was anchored using standard techniques and migrated outward within 7 days, rendering the trial electrode ineffective. The permanent lead was anchored using the described novel technique and remained in position without clinically significant outward migration nor loss in targeted stimulation until the last follow-up at 6 months.ConclusionTrigeminal ganglion stimulation is an effective therapeutic option for medically refractory trigeminal neuropathic pain. The novel surgical adaptation described prevents the outward migration of the lead and enables stable long-term lead placement.
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Affiliation(s)
- Kunal Gupta
- Department of Neurosurgery, Indiana University, Indianapolis, IN, United States
- Stark Neuroscience Research Institute, Indiana University, Indianapolis, IN, United States
- *Correspondence: Kunal Gupta
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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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Hajiabadi MM, Jakobs M, Unterberg A, Ahmadi R. Wireless Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Trigeminal Pain: A Single Center Experience. Neuromodulation 2021; 24:1115-1120. [PMID: 34313358 DOI: 10.1111/ner.13478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Subcutaneous trigeminal nerve field stimulation (sTNFS) is a neuromodulatory treatment for neuropathic trigeminal pain with the ability to reduce the intensity and frequency of pain attacks. However, hardware issues including lead migration, skin erosion, infection, so-called pocket pain at the site of the implanted neurostimulator are reported. Implantable wireless neurostimulation technology promises not only an even less invasive sTNFS treatment and thinner and more flexible electrodes better suited for facial implants, but also provides further advantages such as lack of an implantable neurostimulator and 3T magnetic resonance imaging compatibility. MATERIAL AND METHODS All patients who had received trial stimulation with a partially implantable sTNFS system were analyzed for ICHD-3 (3rd edition of the International Classification of Headache Disorders) diagnosis, success of trial stimulation, pre- and postoperative pain intensity, frequency of attacks, complications, and side-effects of sTNFS. RESULTS All patients (N = 3) responded to sTNFS (≥50% pain reduction) during the trial period. According to ICHD-3, N = 2 of the patients were classified with trigeminal neuralgia (TN) with concomitant persistent facial pain and N = 1 patient with multiple sclerosis associated TN. The time of the test period was 44 ± 31.24 days (mean ± SD). The average daily duration of stimulation per patient amounted 2.5 ± 2.2 hours (range 1-5). The pain intensity (defined on a visual analog scale) was reduced by 80% ± 17% (mean ± SD). Reduction or cessation in pain medication was observed in all patients. No surgical complications occurred in the long-term follow-up period of 18.84 ± 6 (mean ± SD) months. CONCLUSION The partially implantable sTNFS device seems to be safe, effective, and reliable. Compared to conventional devices, the equipment is not limited to the length of trial stimulation. Furthermore, the daily stimulation duration was much shorter compared to previous reports.
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Affiliation(s)
- Mohammad Mehdi Hajiabadi
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.,Division of Surgical Pain Management, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Jakobs
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.,Division of Surgical Pain Management, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rezvan Ahmadi
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.,Division of Surgical Pain Management, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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13
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Ni Y, Yang L, Han R, Guo G, Huang S, Weng L, Wang X, Li Z, Huang D, Hu R, Zhou H. Implantable Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain: A Systematic Review and Meta-Analysis. Neuromodulation 2021; 24:983-991. [PMID: 34008282 DOI: 10.1111/ner.13421] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/27/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Implantable peripheral nerve stimulation has been increasingly used to treat neuropathic pain. This neuromodulation strategy may be an alternative option for intractable trigeminal neuropathic pain; however, evidence for this treatment approach remains limited. A systematic review was conducted to identify studies of patients that underwent peripheral nerve stimulation implantation for trigeminal neuropathic pain. MATERIALS AND METHODS Databases including, PubMed, EMBASE, and Cochrane Library were searched up to October 5, 2020. The primary outcomes were changes in pain scores and response rates of neuromodulation therapy. A random effects model was used for meta-analysis. Subgroup analysis was performed to examine the source of heterogeneity. RESULTS Thirteen studies including 221 participants were evaluated. The estimated response rate of neuromodulation treatment was 61.3% (95% CI: 44.4-75.9%, I2 = 70.733%, p < 0.0001) at the last follow-up. The overall reduction in pain scores was 2.363 (95% CI: 1.408-3.319, I2 = 85.723%, p < 0.0001). Subgroup analysis further confirmed that stimulation target (peripheral branch vs. trigeminal ganglion vs. trigeminal nerve root) contributed the heterogeneity across enrolled studies. Better clinical outcome was associated with stimulation of the trigeminal peripheral branch (p < 0.0001). CONCLUSION Peripheral nerve stimulation may be a promising approach in the management of trigeminal neuropathic pain, especially for patients intractable to conventional therapy.
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Affiliation(s)
- Yuncheng Ni
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Liuqing Yang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Rui Han
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Gangwen Guo
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Shitong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Lili Weng
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Xun Wang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Zhenxing Li
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| | - Rong Hu
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
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14
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Klein J, Siepmann T, Schackert G, Ziemssen T, Juratli TA. Peripheral nerve field stimulation in medically refractory trigeminal neuralgia attributed to multiple sclerosis. J Neurosurg 2021; 134:1244-1250. [DOI: 10.3171/2019.12.jns192261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Case reports and small patient series have suggested peripheral nerve field stimulation (PNFS) as a treatment for refractory trigeminal neuralgia attributed to multiple sclerosis (MS). Here, the authors aimed to assess the effects of this technique on long-term pain severity.
METHODS
Data were prospectively collected on patients with refractory trigeminal neuralgia attributed to MS who underwent PNFS between July 2013 and August 2017 at the authors’ neurosurgical department. Patients were evaluated before and after the first treatment as well as at follow-up at least twice a year. Patients underwent assessment of their pain severity using the Barrow Neurological Institute (BNI) Scale before treatment and at follow-up and were questioned about adverse events following cranial MRI performed after implantation of a permanent PNFS system.
RESULTS
Eight patients (3 women) underwent PNFS trials and their median age was 61 years (IQR 73.75 − 46.5 years). Seven patients proceeded to permanent implantation of the stimulation system. At a median follow-up of 33 months (IQR 42 − 24 months), pain severity decreased from baseline to the last follow-up (BNI score decrease from V [IQR V − V] to III [IQR V − III], p = 0.054). Four patients experienced long-lasting benefit (at 48, 33, 24, and 15 months’ follow-up, respectively), while in 3 patients the treatment eventually failed after an initially successful period. One patient had an infection, requiring system removal and subsequent reimplantation. No other complications occurred. No adverse events were noted in the patients undergoing MRI postimplantation.
CONCLUSIONS
This analysis indicates a possibly beneficial long-term effect of PNFS on refractory trigeminal neuralgia attributed to MS in some patients.
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Affiliation(s)
- Johann Klein
- 1Department of Neurosurgery, University Hospital Carl Gustav Carus
- 3Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden, Germany
| | - Timo Siepmann
- 2Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden; and
- 3Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden, Germany
| | | | - Tjalf Ziemssen
- 2Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden; and
| | - Tareq A. Juratli
- 1Department of Neurosurgery, University Hospital Carl Gustav Carus
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15
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Kohan L, Patel J, Abd-Elsayed A, Riley M. Neuromodulation for the Trigeminal Nerve. TRIGEMINAL NERVE PAIN 2021:155-168. [DOI: 10.1007/978-3-030-60687-9_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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16
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Freiha J, Riachi N, Chalah MA, Zoghaib R, Ayache SS, Ahdab R. Paroxysmal Symptoms in Multiple Sclerosis-A Review of the Literature. J Clin Med 2020; 9:jcm9103100. [PMID: 32992918 PMCID: PMC7600828 DOI: 10.3390/jcm9103100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 01/08/2023] Open
Abstract
Paroxysmal symptoms are well-recognized manifestations of multiple sclerosis (MS). These are characterized by multiple, brief, sudden onset, and stereotyped episodes. They manifest as motor, sensory, visual, brainstem, and autonomic symptoms. When occurring in the setting of an established MS, the diagnosis is relatively straightforward. Conversely, the diagnosis is significantly more challenging when they occur as the initial manifestation of MS. The aim of this review is to summarize the various forms of paroxysmal symptoms reported in MS, with emphasis on the clinical features, radiological findings and treatment options.
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Affiliation(s)
- Joumana Freiha
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (J.F.); (N.R.); (R.Z.)
- Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Naji Riachi
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (J.F.); (N.R.); (R.Z.)
- Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Moussa A. Chalah
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France; (M.A.C.); (S.S.A.)
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France
| | - Romy Zoghaib
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (J.F.); (N.R.); (R.Z.)
- Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Samar S. Ayache
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France; (M.A.C.); (S.S.A.)
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France
| | - Rechdi Ahdab
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (J.F.); (N.R.); (R.Z.)
- Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
- Hamidy Medical Center, Tripoli 1300, Lebanon
- Correspondence: ; Tel.: +961-1-200800 (ext. 5126)
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17
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Han R, Guo G, Ni Y, Wang Z, Yang L, Zhang J, Li X, Hu R, Huang D, Zhou H. Clinical Efficacy of Short-Term Peripheral Nerve Stimulation in Management of Facial Pain Associated With Herpes Zoster Ophthalmicus. Front Neurosci 2020; 14:574713. [PMID: 33100962 PMCID: PMC7546869 DOI: 10.3389/fnins.2020.574713] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Peripheral nerve stimulation may be an alternative option to treat severe facial pain. We assessed the application of peripheral nerve stimulation for pain management in patients with herpes zoster ophthalmicus. Method A retrospective analysis was conducted in patients suffering severe facial pain caused by ophthalmic herpetic lesions. We identified the change in pain severity before and after peripheral nerve stimulation for up to 12 months. Results Eighteen patients were enrolled. Their mean age was 70.8 ± 9.5 years. Fifteen patients presented with subacute pain for 1–3 months, and three patients suffered postherpetic neuralgia. Dramatic relief from pain was achieved in 83% of patients (15 out of 18) upon initial removal of the stimulator, with pain reduction of > 50%. The long-term analgesic effect was reported at the 6- and 12-month follow-ups, with reductions in the visual analog scale of 4.8 ± 1.2 (n = 18) and 5.4 ± 1.4 (n = 11), respectively. The prevalence of postherpetic neuralgia was 7% (1 out of 15) in the subacute pain group. No obvious adverse effect was observed. Conclusion Peripheral nerve stimulation may be an efficacious and safe approach for pain control in patients with herpes zoster ophthalmicus.
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Affiliation(s)
- Rui Han
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Gangwen Guo
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Yuncheng Ni
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Ziyang Wang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Liuqing Yang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Jianping Zhang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Xuelian Li
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Rong Hu
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
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18
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Maragkos GA, Gomez-Paz S, Salem MM, Baum P, Arle J. Non-invasive trial testing for trigeminal branch stimulation to treat refractory trigeminal neuropathic pain: A technical note. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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19
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Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, Obermann M, Cruccu G, Maarbjerg S. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 2020; 19:784-796. [PMID: 32822636 DOI: 10.1016/s1474-4422(20)30233-7] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.
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Affiliation(s)
- Lars Bendtsen
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark.
| | - Joanna Maria Zakrzewska
- Pain Management Centre, National Hospital for Neurology and Neurosurgery, London, UK; Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Tone Bruvik Heinskou
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Paulo Roberto Lacerda Leal
- Department of Neurosurgery, Faculty of Medicine of Sobral, Federal University of Cearà, Sobral, Brazil; University of Lyon, Lyon, France
| | - Turo Nurmikko
- Neuroscience Research Centre, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Stine Maarbjerg
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
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20
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Bina RW, Palsma RS, Weinand ME, Kasoff WS. Peripheral Nerve Stimulation for Refractory Trigeminal Pain: Recent Single‐Institution Case Series With Long‐Term Follow‐Up and Review of the Literature. Neuromodulation 2020; 23:796-804. [DOI: 10.1111/ner.13132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/13/2020] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Robert W. Bina
- Department of Neurosurgery University of Arizona School of Medicine Tucson AZ USA
| | - Ryan S. Palsma
- Department of Neurosurgery University of Arizona School of Medicine Tucson AZ USA
| | - Martin E. Weinand
- Department of Neurosurgery University of Arizona School of Medicine Tucson AZ USA
| | - Willard S. Kasoff
- Department of Neurosurgery University of Arizona School of Medicine Tucson AZ USA
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21
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Kasoff WS, Bina RW. Placement and Anchoring of Trigeminal Neurostimulation Electrodes: Technical Report. Stereotact Funct Neurosurg 2020; 97:285-292. [PMID: 31968343 DOI: 10.1159/000503731] [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] [Received: 06/21/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral neurostimulation (PNS) for medically refractory trigeminal and craniofacial pain is an emerging alternative to traditional surgical approaches. Technical problems with craniofacial PNS have included electrode migration and erosion, limiting the utility and cost-effectiveness of this procedure. OBJECTIVE To review our institutional surgical technique for trigeminal PNS implantation, focusing on a novel technique for electrode anchoring. METHODS Consecutive cases of permanent craniofacial PNS placement by a single surgeon over 36 months were reviewed for surgical technique and technical outcomes. Electrodes were placed percutaneously with open anchoring to the pericranium at a separate parietal incision. RESULTS Sixteen systems (53 electrodes) were implanted in 14 patients. Median follow-up was 13 months (range, 5-29 months). Electrode placement was successful in all cases with no intraoperative complications. There was 1 lead migration (6.3% per patient; 1.8% per lead) and no cases of erosion. Two patients (14.3%) required explant for infection, 1 of whom was successfully reimplanted. Three patients (21.4%) underwent surgical revision other than for infection. CONCLUSIONS We present an improved method for craniofacial PNS surgery which introduces a separate incision for electrode anchoring at the parietal boss. This technique simplifies the procedure and greatly reduces rates of erosion and migration, improving patient comfort and satisfaction.
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Affiliation(s)
- Willard S Kasoff
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA,
| | - Robert W Bina
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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22
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Zeng YJ. Persistent Idiopathic Facial Pain Originating from Cervical Abnormalities. World Neurosurg 2019; 133:248-252. [PMID: 31629148 DOI: 10.1016/j.wneu.2019.10.056] [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: 08/31/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Persistent idiopathic facial pain is characterized by persistent facial or oral pain in the absence of a neurologic deficit. This underexplored pain may be conducted by various nerves, including cranial nerves and upper cervical spinal roots, and its etiology is unclear. CASE DESCRIPTION A patient presented with persistent idiopathic facial pain associated with occipital muscle stiffness after an improper neck massage. The patient achieved almost complete pain relief by coblation of right upper cervical nerves (C1 and C2 spinal roots) followed by continuous cervical epidural analgesia for a period of 3 weeks. The analgesic effect was stable during the 3-month follow-up period. CONCLUSIONS Persistent idiopathic facial pain may be cervicogenic, and treatments focusing on cervical spinal roots may provide satisfactory pain control in patients with cervical abnormalities.
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Affiliation(s)
- Yuan-Jie Zeng
- Joint Surgery and Sport Medicine Department, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
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23
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Sterman J, Cunqueiro A, Dym RJ, Spektor M, Lipton ML, Revzin MV, Scheinfeld MH. Implantable Electronic Stimulation Devices from Head to Sacrum: Imaging Features and Functions. Radiographics 2019; 39:1056-1074. [DOI: 10.1148/rg.2019180088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jonathan Sterman
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Alain Cunqueiro
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - R. Joshua Dym
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Michael Spektor
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Michael L. Lipton
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Margarita V. Revzin
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
| | - Meir H. Scheinfeld
- From the Department of Radiology, Division of Emergency Radiology (J.S., A.C., M.L.L., M.H.S.), Department of Psychiatry and Behavioral Sciences (M.L.L.), and Dominick P. Purpura Department of Neuroscience (M.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467; Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (M.S., M.V.R.)
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24
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Abstract
Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Na
v1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.
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Affiliation(s)
- Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, 38723 Seesen, Germany.,Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
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Gorgulho AA, Fernandes F, Damiani LP, Barbosa DAN, Cury A, Lasagno CM, Bueno PRT, Santos BFO, Santos RHN, Berwanger O, Cavalcanti AB, Teixeira MJ, Moreno RA, De Salles AAF. Double Blinded Randomized Trial of Subcutaneous Trigeminal Nerve Stimulation as Adjuvant Treatment for Major Unipolar Depressive Disorder. Neurosurgery 2018; 85:717-728. [DOI: 10.1093/neuros/nyy420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract
BACKGROUND
More than 30% of major depressive disorder patients fail to respond to adequate trials of medications and psychotherapy. While modern neuromodulation approaches (ie, vagal nerve stimulation, deep brain stimulation) are yet to prove their efficacy for such cases in large randomized controlled trials, trigeminal nerve stimulation (TNS) has emerged as an alternative with promising effects on mood disorders.
OBJECTIVE
To assess efficacy, safety, tolerability, and placebo effect duration of continuous subcutaneous TNS (sTNS) in treatment-resistant depression (TRD).
METHODS
The TREND study is a single-center, double-blind, randomized, controlled, phase II clinical trial. Twenty unipolar TRD patients will receive V1 sTNS as adjuvant to medical therapy and randomized to active vs sham stimulation throughout a 24-wk period. An additional 24-wk open-label phase will follow. Data concerning efficacy, placebo response, relapse, and side effects related to surgery or electrical stimulation will be recorded. We will use the HDRS-17, BDI-SR, IDS_SR30, and UKU scales.
EXPECTED OUTCOMES
The main outcome measure is improvement in depression scores using HAM-17 under continuous sTNS as adjuvant to antidepressants. Active stimulation is expected to significantly impact response and remission rates. Minor side effects are expected due to the surgical procedure and electrical stimulation. The open-label phase should further confirm efficacy and tolerability.
DISCUSSION
This study protocol is designed to define efficacy of a novel adjuvant therapy for TRD. We must strive to develop safe, reproducible, predictable, and well-tolerated neuromodulation approaches for TRD patients impaired to manage their lives and contribute with society.
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Affiliation(s)
| | - Fernando Fernandes
- Mood Disorders Unit (GRUDA), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Lucas P Damiani
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Daniel A N Barbosa
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
| | - Abrão Cury
- Internal Medicine Department, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Camila M Lasagno
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Priscila R T Bueno
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Bruno F O Santos
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
| | - Renato H N Santos
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Otávio Berwanger
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | | | - Manoel J Teixeira
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
- Neurosurgery Discipline, Neurology Department, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Ricardo A Moreno
- Mood Disorders Unit (GRUDA), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
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Current Innovations in Peripheral Nerve Stimulation. PAIN RESEARCH AND TREATMENT 2018; 2018:9091216. [PMID: 30302288 PMCID: PMC6158945 DOI: 10.1155/2018/9091216] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/08/2018] [Accepted: 08/19/2018] [Indexed: 12/17/2022]
Abstract
Peripheral nerve stimulation has been used in the treatment of several chronic pain conditions including pain due to peripheral nerve dysfunctions, complex regional pain syndrome, and cranial neuralgias. It has been shown to be effective for chronic, intractable pain that is refractory to conventional therapies such as physical therapy, medications, transcutaneous electrical stimulations, and nerve blocks. Recently, a new generation of peripheral nerve stimulation devices has been developed; these allow external pulse generators to transmit impulses wirelessly to the implanted electrode, and their implantation is significantly less invasive. In this review, we discuss the history, pathophysiology, indications, implantation process, and outcomes of employing peripheral nerve stimulation to treat chronic pain conditions.
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Delcanho R, Peck C. Neuropathic pain: Diagnosis and treatment from the dental clinic to the multidisciplinary pain clinic. AUST ENDOD J 2018. [DOI: 10.1111/aej.12276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Robert Delcanho
- Perth Orofacial Pain and TMJ Clinic; Subiaco Western Australia Australia
| | - Chris Peck
- Faculty of Dentistry; University of Sydney; Westmead New South Wales Australia
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Weber K. Neuromodulation and Devices in Trigeminal Neuralgia. Headache 2017; 57:1648-1653. [PMID: 28905370 DOI: 10.1111/head.13166] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/26/2017] [Indexed: 01/03/2023]
Abstract
PREMISE Trigeminal neuralgia is a severe facial pain disorder that has been studied for decades. Classical trigeminal neuralgia (CTN) is either idiopathic or caused by neurovascular compression. The related painful trigeminal neuropathies are often secondary to other causes, such as multiple sclerosis or trauma. PROBLEM Therapies for trigeminal neuralgia and neuropathy have often been pharmacologic or surgical. Pharmacologic therapies are not effective in some cases and often cause side effects, some substantial. Surgery can have comorbidity (such as anesthesia dolorosa, or painful differentiation of the affected nerve distribution) and also is not always effective. There is a desire, as in all chronic conditions, to find effective treatments with minimal morbidity and side effects. POTENTIAL SOLUTIONS We review several devices including neuromodulation, ranging in invasiveness, for treatment of trigeminal neuralgia and neuropathy. We review existing data on sphenopalatine ganglion blocks, transcranial magnetic stimulation, transcortical direct stimulation, deep brain stimulation, spinal cord stimulation, peripheral nerve stimulation, and transcutaneous electrical stimulation for CTN and pain trigeminal neuropathies. We also offer hope for further research in this area with the goal of discovering a device that can provide treatment for many with few side effects and minimal morbidity.
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Affiliation(s)
- Kevin Weber
- Department of Neurology, The Ohio State University, Columbus, Ohio (K.Weber)
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30
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Jakobs M, Schuh-Hofer S, Unterberg A, Ahmadi R. Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain. J Vis Exp 2017. [PMID: 28518084 DOI: 10.3791/55408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Chronic or neuropathic trigeminal facial pain can be challenging to treat. Neurosurgical procedures should be applied when conservative treatment fails. Neuromodulation techniques for chronic facial pain include deep brain stimulation and motor cortex stimulation, which are complex to perform. Subcutaneous nerve field stimulation is certified for chronic back pain and is the least invasive form of neuromodulation. We applied this technique to treat chronic and neuropathic trigeminal pain as an individual therapy concept. First, trial stimulation is performed. Subcutaneous leads are placed in the painful trigeminal dermatome under local anesthesia. The leads are connected to an external neurostimulator that applies constant stimulation. Patients undergo a 12 day outpatient trial to assess the effect of the stimulation. Electrodes are removed after the trial. If the patient reports pain reduction of at least 50% in intensity and/or attack frequency, a reduction in medication or increase in quality of life, permanent implantation is scheduled. New electrodes are implanted under general anesthesia and are subcutaneously tunneled to an infraclavicular internal pulse generator. Patients are able to turn stimulation on and off and to increase or decrease the stimulation amplitude as needed. This technique represents a minimal invasive alternative to other more invasive means of neuromodulation for trigeminal pain such as motor cortex stimulation or deep brain stimulation.
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Affiliation(s)
- Martin Jakobs
- Department of Neurosurgery, University Hospital Heidelberg
| | - Sigrid Schuh-Hofer
- Center for Biomedicine and Medical Technology, University Hospital Mannheim
| | | | - Rezvan Ahmadi
- Department of Neurosurgery, University Hospital Heidelberg;
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Weiss AL, Ehrhardt KP, Tolba R. Atypical Facial Pain: a Comprehensive, Evidence-Based Review. Curr Pain Headache Rep 2017; 21:8. [DOI: 10.1007/s11916-017-0609-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Jakobs M, Unterberg A, Treede RD, Schuh-Hofer S, Ahmadi R. Subcutaneous trigeminal nerve field stimulation for refractory trigeminal pain: a cohort analysis. Acta Neurochir (Wien) 2016; 158:1767-74. [PMID: 27372299 DOI: 10.1007/s00701-016-2881-6] [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: 05/13/2016] [Accepted: 06/14/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Neurosurgical pain management of drug-resistant trigeminal neuralgia (TN) is highly challenging. Microvascular decompression is a first-line neurosurgical approach for classical TN with neurovascular conflict, but can show clinical relapse despite proper decompression. Second-line destructive techniques like radiofrequency thermocoagulation have become reluctantly used due to their potential for irreversible side effects. Subcutaneous peripheral nerve field stimulation (sPNFS) is a minimally invasive neuromodulatory technique which has been shown to be effective for chronic localised pain conditions. Reports on sPNFS for the treatment of trigeminal pain (sTNFS) are still sparse and primarily focused on pain intensity as outcome measure. Detailed data on the impact of sTNFS on attack frequency are currently not available. METHODS Patients were classified according to the International Headache Society classification (ICHD-3-beta). Three patients had classical TN without (n = 3) and another three TN with concomitant persistent facial pain (n = 3). Two patients suffered from post-herpetic trigeminal neuropathy (n = 2). All eight patients underwent a trial stimulation of at least 7 days with subcutaneous leads in the affected trigeminal area connected to an external neurostimulator. Of those, six patients received permanent implantation of a neurostimulator. During the follow-up (6-29 months, mean 15.2), VAS-scores, attack frequencies, oral drug intake, complications and side effects were documented. RESULTS Seven out of eight patients responded to sTNFS (i.e. ≥50 % pain reduction) during the test trial. The pain intensity (according to VAS) was reduced by 83 ± 16 % (mean ± SD) and the number of attacks decreased by 73 ± 26 % (mean ± SD). Five out of six patients were able to reduce or stop pain medication. One patient developed device infection. Two patients developed stimulation-related side effects which could be resolved by reprogramming. CONCLUSIONS Treatment by sTNFS is a beneficial option for patients with refractory trigeminal pain. Prospective randomised trials are required to systematically evaluate efficacy rates and safety of this low-invasive neurosurgical technique.
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McRoberts WP. Optimizing Stimulation in a Case of Facial Pain Through "Cross-Talk" of Peripheral and Central Leads: A Case Report. Neuromodulation 2016; 19:885-888. [PMID: 27191684 DOI: 10.1111/ner.12443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/03/2016] [Accepted: 03/10/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe inter-lead (cross-talk) stimulation between a trigeminal nerve lead and a cervical epidural lead for the treatment of facial pain in a 69-year-old patient with empty nose syndrome. MATERIALS AND METHODS A trial implant was performed with a peripheral V2 trigeminal lead and a C1-C2 lead in cross-talk configuration. During permanent implant, the V2 lead was placed uneventfully while the central lead could only be advanced to C3-C4. RESULTS During the trial, pain decreased by 70%. One month after permanent implant, the patient still experienced a 60-70% reduction in pain levels and a decrease from ten to two weekly pain episodes. Nine months post implant, the patient reported complete pain relief (0/10 on a numeric rating scale ranging from 0 to 10) and medications were discontinued. Infrequent exacerbations (3/10) were controlled by increasing stimulation. Three years post implant, the patient continued to have no baseline pain and could easily control exacerbations. CONCLUSION Cross-talk configuration between a peripheral and a central lead created a more efficient stimulation technique. The resulting paresthesia was superior to that obtained from either lead alone and exceeded the paresthesia obtained from the combination of the two leads when used simultaneously, without an inter-lead configuration.
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Levi V, Messina G, Franzini A, Zanin L, Castelli N, Dones I. Peripheral Nerve Field Stimulation (PNFS) as a Treatment Option for Intractable Radiation-Induced Facial Neuropathic Pain in a Survivor of Laryngeal Cancer: A Case Report. World Neurosurg 2016; 91:671.e5-7. [PMID: 27064100 DOI: 10.1016/j.wneu.2016.03.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment-related chronic neuropathic pain represents a major and increasing cause of discomfort in cancer survivors. Unfortunately, in approximately 10%-15% of cases, pain is scarcely relieved by opioids and common painkillers. Thus, alternative measures to manage pain have recently been adopted in these patients. CASE DESCRIPTION We report the case of a laryngeal cancer survivor who developed an intractable bilateral mandibular radiation-induced neuropathic pain syndrome. His pain was refractory to any pharmacological treatment, whereas the implant of bilateral subcutaneous facial electrodes led to the complete resolution of pain. CONCLUSIONS To the best of our knowledge, this is the first report in literature describing peripheral nerve field stimulation as a treatment option for intractable cancer treatment-related chronic neuropathic pain. Peripheral nerve field stimulation appears to be a safe and effective procedure.
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Affiliation(s)
- Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy.
| | - Giuseppe Messina
- Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Angelo Franzini
- Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Luca Zanin
- Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Nicolo Castelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
| | - Ivano Dones
- Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milan, Italy
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Maniam R, Kaye AD, Vadivelu N, Urman RD. Facial Pain Update: Advances in Neurostimulation for the Treatment of Facial Pain. Curr Pain Headache Rep 2016; 20:24. [DOI: 10.1007/s11916-016-0553-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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