Peripheral Nerve Stimulation
by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch M.D
Peripheral Nerve or Peripheral Field Stimulation procedures are becoming increasingly popular for the treatment of many causes of nerve related pain and peripheral neuralgias. This revolutionary treatment works by placing electrodes along the course of painful peripheral nerves to control pain. The stimulation blocks pain perception from traveling from the nerve to the brain. It involves a small device that is placed near the involved nerve that delivers low-level electrical impulses that interfere with the perception of pain, especially chronic nerve pain. One of the main functions of peripheral nerves is to communicate signals from the periphery to the spinal cord to the brain and the rest of the body. Peripheral neuropathy is a disorder involving the peripheral nervous system (PNS). The central nervous system (CNS) includes your brain and spinal cord. The PNS includes all of the nerves from your spinal cord to the rest of your body. Peripheral neuropathy can be caused by many conditions including vitamin deficiencies, alcoholism, autoimmune diseases, certain medications, trauma, unknown causes, and diabetes. When your peripheral nerves become damaged, they do not function properly, and can eventually produce symptoms of pain, tingling, or numbness. The syndromes that may benefit from Peripheral Nerve or Field Stimulation include:
- Complex Regional Pain Syndrome
- Diabetic Peripheral Neuropathy
- Lateral Femoral Cutaneous Neuropathy
- Back and Neck Pain
- Post-Surgical Pain
- Occipital Neuralgia
- Trigeminal Neuralgia
- Traumatic Nerve Injuries
- Peripheral Vascular Disease Neuropathy
- Post-amputation Pain
- Herpetic Neuralgia
- Trigeminal Neuralgia
- Reflex Sympathetic Dystrophy (RSD)
- Complex Regional Pain Syndrome (CRPS)
- Refractory Angina
- Other conditions that have failed conventional therapies.
Peripheral Nerve or Field Stimulation uses an innovative technology that works by introducing an electrical current to the source of chronic pain. Under local anesthetic (numbing agent) and IV sedation your pain physician will place a stimulator lead along the painful nerves. Patients typically undergo a trial for 7 days to see if they feel better and have increased activity with the device. If pain improves, a permanent electrode and battery can be placed. If the permanent device is place, soft thin wires with electrical leads on their tips are placed through a needle under the skin. A small incision is made and the battery is placed under the skin. This device is turned on and releases electrical stimulation to the affected nerves. You pain will be replaced by a tingle instead of the pain originally felt. The entire procedure takes less than a couple of hours to complete, and is done as an outpatient. The stimulator is so small that you can wear bathing suits and continue normal activities without an inconvenience. The stimulator is not visible and lies under the skin. It is a self-contained system much like a pace-maker.
The implanted device produces a low voltage current which creates a sensation that blocks the brain’s ability to sense the previously perceived pain. It interferes with the perception of pain by creating a pleasant sensation that replaces the pain. The intensity of the stimulator can be changed, and the system can be turned on and off as necessary to provide optimal pain relief as experienced by the patient. Treatment of chronic neuropathic pain in the region of the face, neck, and head are challenging for pain specialists to treat. The pain is typically refractory to many of the conventional treatment options. Recently peripheral nerve stimulation has become increasing common in difficult to treat neuropathic facial pain.
Most peripheral nerve stimulation procedures are performed on an outpatient basis. As expected with any surgical procedure, there are potential risks. Side effects that may occur include bleeding, infection, scar tissue deposition, electrode failure, inadequate pain surface area coverage, and nerve damage. While the incision is healing it is important to keep it dry and clean so an infection does not occur. If there is any drainage or redness at the site then you may have developed an infection and your pain specialist must evaluate you. Patients with the following conditions should not receive peripheral nerve stimulation and should talk to their pain specialist about other options:
- Cardiac pacemaker
- Systemic infection
- Pregnancy or lactating
Peripheral nerve stimulation is reported to be an effective pain treatment by the inhibition of nociception (pain perception) and pain from the peripheral nervous system (Ristic 2007). In a clinical investigation of patients receiving peripheral nerve stimulation for craniofacial pain, 73% of the patients experienced significant improvement in pain intensity (Konstantin 2006). With the improvement of pain symptoms after treatment, you may be able to decrease pain medications and increase your daily activities. The number of centers using peripheral nerve stimulation for craniofacial pain and other peripheral nerve syndromes is increasing. In the future there will be a wider acceptance of this treatment because it is minimally invasive, can be tested, is reversible in effect, and has adjustable settings. These unique qualities may eventually make peripheral nerve stimulation the preferred modality for otherwise intractable conditions (Konstantin 2006). Peripheral nerve stimulation can be very effective in reducing chronic pain from certain painful conditions, however it does not work for everyone. A trial with a temporary device is usually done before you have a permanent device placed, which ensures good response to therapy. For those that it does help it is an innovative treatment that brings significant relief. You should contact Arizona Pain Specialists now to speak with a physician to see if this treatment can benefit you. We are happy to offer this service as a pain management tool for patients in the Phoenix area.
Trigeminal and Occipital Peripheral Nerve Stimulation for Craniofacial Pain: A Single-institution Experience and Review of the Literature Konstantin V. Slavin, M.D.; M. Efkan Colpan, M.D.; Naureen Munawar, M.D.; Christian Wess, M.D.; Hrachya Nersesyan, M.D., Ph.D. Neurosurg Focus. 2006;21(6) 2006 American Association of Neurological Surgeons Analgesic and antinociceptive effects of peripheral nerve neurostimulation in an advanced human experimental model. Ristic D, Spangenberg P, Ellrich J. Eur J Pain. 2007 Sep 17