gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Peripheral subcutaneous nerve stimulation

Meeting Abstract

Search Medline for

  • A. Koulousakis - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.03-04

DOI: 10.3205/09dgnc180, URN: urn:nbn:de:0183-09dgnc1806

Published: May 20, 2009

© 2009 Koulousakis.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: After the introduction of stimulation techniques for the treatment of chronic pain by means of SCS and PNS in the 70s, PNS-stimulation for treating Mononeuropathy, as well as sympathetic pain, underwent a renaissance. PNS techniques were introduced for treatment of CRPS I, occipital neuralgia, migraine, as well as neuropathies.

Methods: Following the convincing results, introduced by Barolat 2004, we performed a so called “Field Nerve Stimulation” pilot study from May 2005 to February 2006.

Indication was a well described exactly localized area of pain. After the exclusion of radicular pain, this method was considered the first step of invasive pain therapy on the neurosurgical pain scale, which was independent of medication. 12 patients suffered of lumbar pain syndrome, 3 of occipital neuralgia, 3 of knee pain, 3 of root avulsion, one of post-thoracotomy syndrome, 4 of neuropathic facial pain, 2 of phantom pain, 2 of CRPS I, as well as one pain syndrome after inguinal hernia. The patients were assessed, both post-operatively and after a follow-up period of one year, using the VAS scale. Leads were placed, allowing accessing the outer border of the area of pain.

After a one-week trial, the trial electrodes were removed and replaced by permanent subcutaneous electrodes in the same location, which were later connected to a completely programmable generator. 11 out of 31 Patients, who received an implantation of one to four leads (quadrode/octrode) and then underwent a one-week trial-phase, received an implantation of a complete system.

Results: Approximately 30% of the patients displayed a pain relief of more than 50% for a period of up to one year. 16 patients, who did not profit from peripheral nerve stimulation, were treated by SCS, according to our therapy scale. Since an adequate pain relief could not be achieved by SCS either, it can be assumed that simple subcutaneous stimulation can serve as a predictor for the success of spinal stimulation. In addition, patients who subsequently received an intrathecal opiate therapy showed significantly weaker results than other patients.

Conclusions: Peripheral nerve stimulation is a simple, promising method, with the best indication being a well localizable pain, and can be considered as the first step of invasive pain therapy for treating well described pain emission. The operation technique is very simple and of low risk, however, long-term results have to be awaited.