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. 2008 Jan;5(1):100–106. doi: 10.1016/j.nurt.2007.11.005

Peripheral nerve stimulation for neuropathic pain

Konstantin V Slavin 1,
PMCID: PMC5084131  PMID: 18164488

Summary

Peripheral nerve stimulation (PNS) has been used for treatment of neuropathic pain for more than 40 years. Recent resurgence of interest to this elegant surgical modality came from the introduction of less invasive implantation techniques and the wider acceptance of neuromodulation as a treatment of medically refractory cases. This article reviews the literature on the use of PNS for neuropathic pain and describes current indications and hardware choices in frequent use. Published experience indicates that neuropathic pain responds to PNS in many patients. PNS works well in both established indications, such as post-traumatic and postsurgical neuropathy, occipital neuralgia, and complex regional pain syndromes, and in relatively new indications for neuromodulation, such as migraines and daily headaches, cluster headaches, and fibromyalgia. Future research and growing clinical experience will help in identifying the best candidates for PNS, choosing the best procedure and best hardware for each individual patient, and defining adequate expectations for patients and pain specialists.

Key Words: Neuromodulation, neuropathic pain, migraine, headache, occipital neuralgia, cluster headache, fibromyalgia

References

  • 1.Beemer GH, Reeves JH, Bjorksten AR. Accurate monitoring of neuromuscular blockade using a peripheral nerve stimulator: a review. Anaesth Intensive Care. 1990;18:490–496. doi: 10.1177/0310057X9001800414. [DOI] [PubMed] [Google Scholar]
  • 2.Rowlee SC. Monitoring neuromuscular blockade in the intensive care unit: the peripheral nerve stimulator. Heart Lung. 1999;28:352–364. doi: 10.1053/hl.1999.v28.a99734. [DOI] [PubMed] [Google Scholar]
  • 3.Chervin RD, Guilleminault C. Diaphragm pacing for respiratory insufficiency. J Clin Neurophysiol. 1997;14:369–377. doi: 10.1097/00004691-199709000-00003. [DOI] [PubMed] [Google Scholar]
  • 4.Donaldson Nde N, Rushton DN, Perkins TA, Wood DE, Norton J, Krabbendam AJ. Recruitment by motor nerve root stimulators: significance for implant design. Med Eng Phys. 2003;25:527–537. doi: 10.1016/S1350-4533(03)00051-1. [DOI] [PubMed] [Google Scholar]
  • 5.Popovic MR, Popovic DB, Keller T. Neuroprostheses for grasping. Neurol Res. 2002;24:443–452. doi: 10.1179/016164102101200311. [DOI] [PubMed] [Google Scholar]
  • 6.Graupe D. An overview of the state of the art of noninvasive FES for independent ambulation by thoracic level paraplegics. Neurol Res. 2002;24:431–442. doi: 10.1179/016164102101200302. [DOI] [PubMed] [Google Scholar]
  • 7.Groves DA, Brown VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neurosci Biobehav Rev. 2005;29:493–500. doi: 10.1016/j.neubiorev.2005.01.004. [DOI] [PubMed] [Google Scholar]
  • 8.Walsh SP, Kling MA. VNS and depression: current status and future directions. Expert Rev Med Devices. 2004;1:155–160. doi: 10.1586/17434440.1.1.155. [DOI] [PubMed] [Google Scholar]
  • 9.Oerlemans DJ, van Kerrebroeck PE. Sacral nerve stimulation for neuromodulation of the lower urinary tract. Neurourol Urodyn 2007 Jun 11 [Epub ahead of print]. [DOI] [PubMed]
  • 10.Holzer B, Rosen HR, Novi G, Ausch C, Hölbling N, Schiessel R. Sacral nerve stimulation for neurogenic faecal incontinence. Br J Surg. 2007;94:749–753. doi: 10.1002/bjs.5499. [DOI] [PubMed] [Google Scholar]
  • 11.Slavin KV, Burchiel KJ. Peripheral nerve stimulation for painful nerve injuries. Contemp Neurosurg. 1999;21(19):1–6. [Google Scholar]
  • 12.Melzack RA, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–979. doi: 10.1126/science.150.3699.971. [DOI] [PubMed] [Google Scholar]
  • 13.Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967;155:108–109. doi: 10.1126/science.155.3758.108. [DOI] [PubMed] [Google Scholar]
  • 14.White JC, Sweet WH. Pain and the neurosurgeon: a forty-year experience. Springfield, IL: Thomas; 1969. pp. 894–899. [Google Scholar]
  • 15.Shelden CH. Depolarization in the treatment of trigeminal neuralgia. Evaluation of compression and electrical methods; clinical concept of neurophysiological mechanism. In: Knighton RS, Dumke PR, editors. Pain. Boston: Little, Brown; 1966. pp. 373–386. [Google Scholar]
  • 16.Cauthen JC, Renner EJ. Transcutaneous and peripheral nerve stimulation for chronic pain states. Surg Neurol. 1975;4:102–104. [PubMed] [Google Scholar]
  • 17.Kirsch WM, Lewis JA, Simon RH. Experiences with electrical stimulation devices for the control of chronic pain. Med Instrum. 1975;9:217–220. [PubMed] [Google Scholar]
  • 18.Picaza JA, Cannon BW, Hunter SE, Boyd AS, Guma J, Maurer D. Pain suppression by peripheral nerve stimulation: II. Observations with implanted devices. Surg Neurol. 1975;4:115–126. [PubMed] [Google Scholar]
  • 19.Campbell JN, Long DM. Peripheral nerve stimulation in the treatment of intractable pain. J Neurosurg. 1976;45:692–699. doi: 10.3171/jns.1976.45.6.0692. [DOI] [PubMed] [Google Scholar]
  • 20.Sweet WH. Control of pain by direct stimulation of peripheral nerves. Clin Neurosurg. 1976;23:103–111. doi: 10.1093/neurosurgery/23.cn_suppl_1.103. [DOI] [PubMed] [Google Scholar]
  • 21.Nashold BS, Mullen JB, Avery R. Peripheral nerve stimulation for pain relief using a multicontact electrode system: technical note. J Neurosurg. 1979;51:872–873. doi: 10.3171/jns.1979.51.6.0872. [DOI] [PubMed] [Google Scholar]
  • 22.Law JD, Sweet J, Kirsch WM. Retrospective analysis of 22 patients with chronic pain treated by peripheral nerve stimulation. J Neurosurg. 1980;52:482–485. doi: 10.3171/jns.1980.52.4.0482. [DOI] [PubMed] [Google Scholar]
  • 23.Long DM, Erickson D, Campbell J, North R. Electrical stimulation of the spinal cord and peripheral nerves for pain control: a 10-year experience. Appl Neurophysiol. 1981;44:207–217. doi: 10.1159/000102203. [DOI] [PubMed] [Google Scholar]
  • 24.Nashold BS, Goldner JL, Mullen JB, Bright DS. Long-term pain control by direct peripheral nerve stimulation. J Bone Joint Surg Am. 1982;64:1–10. [PubMed] [Google Scholar]
  • 25.Waisbrod H, Panhans C, Hansen D, Gerbeshagen HU. Direct nerve stimulation for painful peripheral neuropathies. J Bone Joint Surg Br. 1985;67:470–472. doi: 10.1302/0301-620X.67B3.2987272. [DOI] [PubMed] [Google Scholar]
  • 26.Long DM. Stimulation of the peripheral nervous system for pain control. Clin Neurosurg. 1986;33:323–343. doi: 10.1093/neurosurgery/31.cn_suppl_1.323. [DOI] [PubMed] [Google Scholar]
  • 27.Iacono RP, Linford J, Sandyk R. Pain management after lower extremity amputation. Neurosurgery. 1987;20:496–500. doi: 10.1227/00006123-198703000-00027. [DOI] [PubMed] [Google Scholar]
  • 28.Racz GB, Browne T, Lewis R. Peripheral stimulator implant for treatment of causalgia caused by electrical burns. Tex Med. 1988;84:45–50. [PubMed] [Google Scholar]
  • 29.Heavner JE, Racz G, Diede JM. Peripheral nerve stimulation: current concepts. In: Waldman SD, Winnic AP, editors. Interventional pain management. 1st ed. Philadelphia: W.B. Saunders; 1996. pp. 423–425. [Google Scholar]
  • 30.Hassenbusch SJ, Stanton-Hicks M, Schoppa D, Walsh JG, Covington EC. Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy. J Neurosurg. 1996;84:415–423. doi: 10.3171/jns.1996.84.3.0415. [DOI] [PubMed] [Google Scholar]
  • 31.Stanton-Hicks M, Salamon J. Stimulation of the central and peripheral nervous system for the control of pain. J Clin Neurophysiol. 1997;14:46–62. doi: 10.1097/00004691-199701000-00004. [DOI] [PubMed] [Google Scholar]
  • 32.Shetter AG, Racz GB, Lewis R, Heavner JE. Peripheral nerve stimulation. In: North RB, Levy RM, editors. Neurosurgical management of pain. New York: Springer; 1997. pp. 261–270. [Google Scholar]
  • 33.Nielson KD, Watts C, Clark WK. Peripheral nerve injury from implantation of chronic stimulating electrodes for pain control. Surg Neurol. 1976;5:51–53. [PubMed] [Google Scholar]
  • 34.Weiner RL, Reed KL. Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation. 1999;2:217–221. doi: 10.1046/j.1525-1403.1999.00217.x. [DOI] [PubMed] [Google Scholar]
  • 35.Slavin KV, Burchiel KJ. Use of long-term nerve stimulation with implanted electrodes in the treatment of intractable craniofacial pain. J Neurosurg. 2000;92:576–576. [Google Scholar]
  • 36.Weiner RL. The future of peripheral nerve stimulation. Neurol Res. 2000;22:299–304. doi: 10.1080/01616412.2000.11740674. [DOI] [PubMed] [Google Scholar]
  • 37.Lou L. Uncommon areas of electrical stimulation. Curr Rev Pain. 2000;4:407–412. doi: 10.1007/s11916-000-0025-3. [DOI] [PubMed] [Google Scholar]
  • 38.Hammer M, Doleys DM. Perineuromal stimulation in the treatment of occipital neuralgia: a case study. Neuromodulation. 2001;4:47–51. doi: 10.1046/j.1525-1403.2001.00047.x. [DOI] [PubMed] [Google Scholar]
  • 39.Weiner RL, Aló KM, Reed KL, Fuller ML. Subcutaneous neurostimulation for intractable C-2-mediated headaches. J Neurosurg. 2001;94:398A–398A. [Google Scholar]
  • 40.Dunteman E. Peripheral nerve stimulation for unremitting ophthalmic postherpetic neuralgia. Neuromodulation. 2002;5:32–37. doi: 10.1046/j.1525-1403.2002._2006.x. [DOI] [PubMed] [Google Scholar]
  • 41.Aló KM, Holsheimer J. New trends in neuromodulation for the management of neuropathic pain. Neurosurgery. 2002;50:690–704. doi: 10.1097/00006123-200204000-00003. [DOI] [PubMed] [Google Scholar]
  • 42.Weiner RL. Peripheral nerve neurostimulation. Neurosurg Clin N Am. 2003;14:401–408. doi: 10.1016/S1042-3680(03)00037-8. [DOI] [PubMed] [Google Scholar]
  • 43.Popeney CA, Aló KM. Peripheral neurostimulation for the treatment of chronic, disabling transformed migraine. Headache. 2003;43:369–375. doi: 10.1046/j.1526-4610.2003.03072.x. [DOI] [PubMed] [Google Scholar]
  • 44.Jones RL. Occipital nerve stimulation using a Medtronic Resume II® electrode array. Pain Physician. 2003;6:507–508. [PubMed] [Google Scholar]
  • 45.Johnson MD, Burchiel KJ. Peripheral stimulation for treatment of trigeminal postherpetic neuralgia and trigeminal posttraumatic neuropathic pain: a pilot study. Neurosurgery. 2004;55:135–142. [PubMed] [Google Scholar]
  • 46.Matharu MS, Bartsch, Ward N, Frackowiak RSJ, Weiner R, Goadsby PJ. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain. 2004;127:220–230. doi: 10.1093/brain/awh022. [DOI] [PubMed] [Google Scholar]
  • 47.Oh MY, Ortega J, Bellotte JB, Whiting DM, Aló K. Peripheral nerve stimulation for the treatment of occipital neuralgia and transformed migraine using a C1-2-3 subcutaneous paddle style electrode: a technical report. Neuromodulation. 2004;7:103–112. doi: 10.1111/j.1094-7159.2004.04014.x. [DOI] [PubMed] [Google Scholar]
  • 48.Slavin KV, Wess C. Trigeminal branch stimulation for intractable neuropathic pain: a technical note. Neuromodulation. 2005;8:7–13. doi: 10.1111/j.1094-7159.2005.05215.x. [DOI] [PubMed] [Google Scholar]
  • 49.Kapural L, Mekhail N, Hayek SM, Stanton-Hicks M, Malak O. Occipital nerve electrical stimulation via the midline approach and subcutaneous surgical leads for treatment of severe occipital neuralgia: a pilot study. Anesth Analg. 2005;101:171–174. doi: 10.1213/01.ANE.0000156207.73396.8E. [DOI] [PubMed] [Google Scholar]
  • 50.Rodrigo-Royo MD, Azcona JM, Quero J, Lorente MC, Acín P, Azcona J. Peripheral neurostimulation in the management of cervicogenic headaches: four case reports. Neuromodulation. 2005;4:241–248. doi: 10.1111/j.1525-1403.2005.00032.x. [DOI] [PubMed] [Google Scholar]
  • 51.Slavin KV, Nersesyan H, Wess C. Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery. 2006;58:112–119. doi: 10.1227/01.NEU.0000192163.55428.62. [DOI] [PubMed] [Google Scholar]
  • 52.Slavin KV, Nersesyan H, Wess C. In: Meglio M, Krames ES, editors. Treatment of neuropathic craniofacial pain using peripheral nerve stimulation approach; Bologna: Medimond International Proceedings; 2005. pp. 77–80. [Google Scholar]
  • 53.Weiner RL. Occipital neurostimulation for treatment of intractable headache syndromes. Acta Neurochir Suppl. 2007;97:129–133. doi: 10.1007/978-3-211-33079-1_18. [DOI] [PubMed] [Google Scholar]
  • 54.Schwedt TJ, Dodick DW, Trentman TL, Zimmerman RS. Occipital nerve stimulation for chronic cluster headache and hemicrania continua: pain relief and persistence of autonomic features. Cephalalgia. 2006;26:1025–1027. doi: 10.1111/j.1468-2982.2006.01142.x. [DOI] [PubMed] [Google Scholar]
  • 55.Slavin KV, Colpan ME, Munawar N, Wess C, Nersesyan H. Trigeminal and occipital peripheral nerve stimulation for craniofacial pain: a single-institution experience and review of the literature. Neurosurg Focus. 2006;21(6):E5–E5. doi: 10.3171/foc.2006.21.6.8. [DOI] [PubMed] [Google Scholar]
  • 56.Rogers LL, Swidan S. Stimulation of the occipital nerve for the treatment of migraine: current state and future prospects. Acta Neurochir Suppl. 2007;97:121–128. doi: 10.1007/978-3-211-33079-1_17. [DOI] [PubMed] [Google Scholar]
  • 57.Thimineur M, De Ridder D. C2 area neurostimulation: a surgical treatment for fibromyalgia. Pain Med. 2007;8:639–646. doi: 10.1111/j.1526-4637.2007.00365.x. [DOI] [PubMed] [Google Scholar]
  • 58.Magis D, Allena M, Bolla M, De Pasqua V, Remacle JM, Schoenen J. Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol. 2007;6:314–321. doi: 10.1016/S1474-4422(07)70058-3. [DOI] [PubMed] [Google Scholar]
  • 59.Bums B, Watkins L, Goadsby PJ. Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet. 2007;369:1099–1106. doi: 10.1016/S0140-6736(07)60328-6. [DOI] [PubMed] [Google Scholar]
  • 60.Schwedt TJ, Dodick DW, Hentz J, Trentman TL, Zimmerman RS. Occipital nerve stimulation for chronic headache: long-term safety and efficacy. Cephalalgia. 2007;27:153–157. doi: 10.1111/j.1468-2982.2007.01272.x. [DOI] [PubMed] [Google Scholar]
  • 61.Hagen JE, Bennett DS. Occipital nerve stimulation for treatment of migraine. Practical Pain Management. 2007;7(6):43–45. [Google Scholar]
  • 62.Stinson LW, Roderer GT, Cross NE, Davis BE. Peripheral subcutaneous electrostimulation for control of intractable postoperative inguinal pain: a case report series. Neuromodulation. 2001;4:99–104. doi: 10.1046/j.1525-1403.2001.00099.x. [DOI] [PubMed] [Google Scholar]
  • 63.Paicius RM, Bernstein CA, Lempert-Cohen C. Peripheral nerve field stimulation for the treatment of chronic low back pain: preliminary results of long-term follow-up: a case series. Neuromodulation. 2007;10:279–290. doi: 10.1111/j.1525-1403.2007.00116.x. [DOI] [PubMed] [Google Scholar]
  • 64.Yakovlev AE, Peterson AT. Peripheral nerve stimulation in treatment of intractable postherpetic neuralgia. Neuromodulation. 2007;10:373–375. doi: 10.1111/j.1525-1403.2007.00126.x. [DOI] [PubMed] [Google Scholar]
  • 65.Kothari S. Neuromodulatory approaches to chronic pelvic pain and coccygodynia. Acta Neurochir Suppl. 2007;97:365–371. doi: 10.1007/978-3-211-33079-1_48. [DOI] [PubMed] [Google Scholar]
  • 66.Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle, WA: IASP Press; 1994. [Google Scholar]
  • 67.Doleys DM. Psychological factors in spinal cord stimulation therapy: brief review and discussion. Neurosurg Focus. 2006;21(6):E1–E1. doi: 10.3171/foc.2006.21.6.4. [DOI] [PubMed] [Google Scholar]
  • 68.Monti E. Peripheral nerve stimulation: a percutaneous minimally invasive approach. Neuromodulation. 2004;7:193–196. doi: 10.1111/j.1094-7159.2004.04195.x. [DOI] [PubMed] [Google Scholar]
  • 69.Leone M, Franzini A, Cecchini AP, Broggi G, Bussone G. Stimulation of occipital nerve for drug-resistant chronic cluster headache. Lancet Neurol. 2007;6:289–291. doi: 10.1016/S1474-4422(07)70061-3. [DOI] [PubMed] [Google Scholar]
  • 70.Slavin KV. Peripheral neurostimulation in fibromyalgia: a new frontier?! Pain Med. 2007;8:621–622. doi: 10.1111/j.1526-4637.2007.00328.x. [DOI] [PubMed] [Google Scholar]
  • 71.Mauskop A. Vagus nerve stimulation relieves chronic refractory migraine and cluster headaches. Cephalalgia. 2005;25:82–86. doi: 10.1111/j.1468-2982.2005.00611.x. [DOI] [PubMed] [Google Scholar]
  • 72.Syed M, Slavin KV. In: Meglio M, Krames ES, editors. Infraclavicular generator placement for neurostimulation: are the patients satisfied?; Bologna: Medimond International Proceedings; 2005. pp. 81–84. [Google Scholar]
  • 73.Loeb GE, Peck RA, Moore WH, Hood K. BION system for distributed neural prosthetic interfaces. Med Eng Physics. 2001;23:9–18. doi: 10.1016/S1350-4533(01)00011-X. [DOI] [PubMed] [Google Scholar]
  • 74.Groen J, Amiel C, Bosch JL. Chronic pudendal nerve neuromodulation in women with idiopathic refractory detrusor overactivity incontinence: results of a pilot study with a novel minimally invasive implantable mini-stimulator. Neurourol Urodyn. 2005;24:226–230. doi: 10.1002/nau.20131. [DOI] [PubMed] [Google Scholar]
  • 75.Carbunaru R, Whitehurst T, Jaax K, Koff J, Makous J. Rechargeable battery-powered Bion microstimulators for neuromodulation. Conf Proc IEEE Eng Med Biol Soc. 2004;6:4193–4196. doi: 10.1109/IEMBS.2004.1404170. [DOI] [PubMed] [Google Scholar]
  • 76.Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain. 2002;125:1496–1509. doi: 10.1093/brain/awf166. [DOI] [PubMed] [Google Scholar]
  • 77.Le Doaré K, Akerman S, Holland PR, et al. Occipital afferent activation of second order neurons in the trigeminocervical complex in rat. Neurosci Lett. 2006;403:73–77. doi: 10.1016/j.neulet.2006.04.049. [DOI] [PubMed] [Google Scholar]
  • 78.Navarro X, Krueger TB, Lago N, Micera S, Stieglitz T, Dario P. A critical review of interfaces with the peripheral nervous system for the control of neuroprosthesis and hybrid bionic systems. J Periph Nerv Syst. 2005;10:229–258. doi: 10.1111/j.1085-9489.2005.10303.x. [DOI] [PubMed] [Google Scholar]
  • 79.Haque R, Winfree CJ. Spinal nerve root stimulation. Neurosurg Focus. 2006;21(6):E4–E4. doi: 10.3171/foc.2006.21.6.7. [DOI] [PubMed] [Google Scholar]
  • 80.Machado A, Ogrin M, Rosenow JM, Henderson JM. A 12-month prospective study of gasserian ganglion stimulation for trigeminal neuropathic pain. Stereotact Funct Neurosurg. 2007;85:216–224. doi: 10.1159/000103260. [DOI] [PubMed] [Google Scholar]

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