Artikel
Subcutaneous Peripheral Nerve(-field) Stimulation (sPNS) in neuropathic pain – a case series
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Veröffentlicht: | 21. Mai 2013 |
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Objective: The subcutaneous peripheral nerve field stimulation (sPNS), as a minimal invasive and fully reversible neuromodulation technique, seems to be a promising treatment option for pain. This prospective study is designed to evaluate the efficacy of this method for the treatment of neuropathic pain.
Method: Patients suffering from circumscribed permanent pain at diverse localizations were enrolled to this trial, if the conservative therapy had failed. Eight-electrode testing-leads (octrodes) were placed subcutaneously into the region of interest (ROI). The electrodes were programmed postoperatively. After a 7±2 day trial the decision for a final implantation of a sPNS-system was made if the pain was reported to be decreased by at least 50 %. The pain intensity and quality of life was assessed by the German pain questionnaire “Deutscher Schmerz-Fragebogen” before and after the trial period. A short-time follow-up was done about four weeks after the final sPNS-system implantation.
Results: Four patients with neuropathic pain were treated by sPNS. In three of four cases (Meralgia paresthetica, parasacral pain and bilateral nape pain) two testing-leads were placed, followed by a final implantation of a sPNS-system after the trial period owing to 70 % pain reduction on average. After final implantation of the system, all patients reported about a significant improvement of quality of life. A single testing-lead was used in the genitofemoral neuropathy only. This patient didn't receive a sPNS-system because there was no reported change in pain at all.
Conclusions: The sPNS in dual-lead approach should be considered as an early effective, minimal invasive and fully reversible therapy modality in patients with circumscribed neuropathic pain. A long time follow-up with recruitment of more neuropathic pain patients is needed to clarify the complications, the long-time (side) effects and the advantage over other known neuromodulation techniques.