Peripheral Nerve Stimulation in Treatment of Intractable Postherpetic Neuralgia

Objective. This case report presents an application of peripheral nerve stimulation to a patient with intractable postherpetic neuralgia that conventional treatment failed to ameliorate. Methods. The patient underwent an uneventful peripheral nerve stimulator trial with placement of two temporal eight‐electrode percutaneous leads (Octrode leads, Advanced Neuromodulation Systems, Plano, TX, USA) into the right subscapular and right paraspinal area of the upper thoracic region. Results. Upon experiencing excellent pain relief over the next two weeks, the patient underwent implantation of permanent leads two weeks later and reported sustained pain relief. Conclusion. Peripheral nerve stimulation offers an alternative treatment option for intractable pain associated with postherpetic neuralgia, especially for elderly patients where treatment options are limited due to existing comorbidities. Further studies are warranted.     

Peripheral Nerve Field Stimulation in the Treatment of Postlaminectomy Syndrome after Multilevel Spinal Surgeries

Introduction: Chronic low back pain in patients with postlaminectomy syndrome (PLS) is challenging to treat, especially for patients who have undergone multilevel surgical procedures. Despite conservative therapy and available interventional pain procedures including spinal cord stimulation (SCS) and intrathecal therapies, patients may continue with intractable low back pain. Peripheral nerve field stimulation (PNFS) may represent an effective alternative treatment option for these patients when conventional treatments do not provide adequate relief of intractable low back pain. Methods: Eighteen patients underwent an uneventful PNFS trial with percutaneous placement of four temporary quadripolar leads (Medtronic, Inc., Minneapolis, MN, USA) placed subcutaneously over the lumbar or thoraco‐lumbar area. Results: After experiencing excellent pain relief over the next two days, temporary leads were removed. The patients were implanted with permanent leads and rechargeable or non‐rechargeable generator two to four weeks after temporary lead removal. All patients reported sustained pain relief 12 months after implantation. Discussion: PNFS with use of four vertically orientated leads provides an effective treatment option for patients with PLS after multilevel surgical procedures with intractable low back pain who have failed conservative treatment. PNFS may provide pain relief with advantages over conservative treatments and interventional treatments including SCS and intrathecal therapy. Conclusion: PNFS may be more effective in treating intractable low back pain than SCS in patients with PLS after multilevel spinal surgeries.     

Peripheral Nerve Stimulation for Unremitting Ophthalmic Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is a common cause of chronic pain in the elderly. Opioids and adjunctive analgesics such as antidepressants and anticonvulsants effectively reduce discomfort in many patients, while others have pain that remains resistant to all forms of therapy. Spinal cord stimulation has shown promise for severe truncal and extremity PHN, but has no impact on neuralgias of cranial nerve origin. Peripheral nerve stimulation has been described for such problems as chronic regional pain syndrome, but to date has not been reported for cranial nerve syndromes. This article describes the cases in which an 86‐year‐old man and a 76‐year‐old woman with intractable PHN of greater than 6 and 4 years, respectively, were effectively treated with peripheral nerve stimulation of the ophthalmic division of the trigeminal nerve.     

Peripheral Nerve Field Stimulation: Is Age an Indicator of Outcome?

Objective. This study aims to assess peripheral nerve field stimulation as a treatment option for chronic pain and test for indicators of outcome. Materials and Methods. We reviewed all patients permanently implanted with peripheral nerve field stimulators over the past 24 months. A questionnaire was used to assess outcomes. Results. Twenty‐seven questionnaires were sent out and 23/27 responded. A significant average decrease of 4.02 visual analog scale points was observed. The average pain decrease for the low back was 3.77 points and 5.9 for occipital implants. An age effect was detected; younger patients (<60 years) reported an average pain relief of 4.79 points while older patients (>61 years) reported an average pain relief decrement of only 2.83 points. Most patients reported decreases in analgesic use after treatment. Pain relief was significantly and highly correlated with reduced analgesic intake and patient satisfaction. Conclusion. Peripheral nerve field stimulation is a safe, reversible, and effective treatment option for patients with chronic pain, particularly those under 60 years.