Neurosurgery clinics of North America
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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.
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Chronic pain impairs the quality of life for millions of individuals and therefore presents a serious ongoing challenge to clinicians and researchers. Debilitating chronic pain syndromes cost the US economy more than $600 billion per year. This article provides an overview of the epidemiology, clinical presentation, and treatment outcomes for craniofacial, spinal, and peripheral neurologic pain syndromes. Although the authors recognize that the diagnosis and treatment of the chronic forms of neuropathic pain syndromes represent a clinical challenge, there is an urgent need for standardized classification systems, improved epidemiologic data, and reliable treatment outcomes data.
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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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Neurosurg. Clin. N. Am. · Oct 2014
ReviewPercutaneous spinal cord stimulation for chronic pain: indications and patient selection.
Percutaneous spinal cord stimulation has a clinical benefit in selected patients with chronic neuropathic pain related to failed back surgery syndrome and complex regional pain syndrome. Patients with other peripheral neuropathic pain syndromes may also respond favorably. The cause of the chronic pain must be established to rule out remediable causes. ⋯ A psychological evaluation identifies patients who may not benefit. Risk factors for infection should be corrected where possible. This safe, reversible treatment should be considered early for patients with intractable peripheral neuropathic pain.