Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 2014
ReviewNeurolysis, neurectomy, and nerve repair/reconstruction for chronic pain.
Neuropathic pain may be a result of focal injury to a peripheral nerve. The treatment algorithm begins with nonoperative, then operative, options. ⋯ Neurectomy is an option in primary cases where numbness is an acceptable alternative to dysesthetic pain, or as an alternative following failed neurolysis. Nerve repair or reconstruction may improve pain by guiding axons past the neuroma.
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Motor cortex stimulation produces significant relief of symptoms in many forms of refractory chronic pain disorders.
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Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment modality for patients with chronic neuropathic pain syndromes. The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of neural target, and duration of treatment. TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression, respectively. Long-term randomized controlled studies are warranted to establish the efficacy of repetitive TMS in patients with various chronic pain syndromes.
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Trigeminal neuralgia (TN) is a neurologic disorder, defined by paroxysmal electric shocklike painful attacks in 1 or more trigeminal nerve branches. Treatment of TN is diverse and includes minimally invasive percutaneous techniques, which consist of balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation. Although all 3 techniques are generally safe, efficient, and effective, a clear consensus has not been reached regarding their specific indications and degree of efficacy. The aim of this article is to describe the percutaneous treatments available for TN and outline their characteristics, technique, indications and efficacy.
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Peripheral nerve stimulation and peripheral nerve field stimulation involve the delivery of electrical stimulation using implanted electrodes either over a target nerve or over the painful area with the goal of modulating neuropathic pain. The selection of appropriate candidates for this therapy hinges on skillful application of inclusion and exclusion criteria, psychological screening, and an invasive screening trial. Patients with significant improvement in pain severity and pain-related disability during the trial are considered candidates for implantation of a permanent system. As with other implanted devices for neuromodulation, risks of mechanical failures, infection, and neurologic complications exist.