Changes for page Chapter 7: Percutaneous Peripheral Nerve Stimulation

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1	1	= Authors =
2	2
3		-Kenneth M. Alo`* *, MD
4		-Marina V. Abramova*, MD
5		-Erich O. Richter*, MD
	3	+Kenneth M. Alo`* *, MD - Houston Texas Pain Management, Houston Texas
	4	+Marina V. Abramova*, MD - LSU Health Sciences Center, New Orleans, Louisiana
	5	+Erich O. Richter*, MD - LSU Health Sciences Center, New Orleans, Louisiana
6	6
7		-* LSU Health Sciences Center, New Orleans, Louisiana
8		-* * Houston Texas Pain Management, Houston Texas
	7	+= Abstract =
9	9
	9	+Since its inception in the 1970s, peripheral neuromodulation has become an increasingly common procedure to treat chronic neuropathic disorders. Historically, peripheral nerve stimulation (PNS) originated with the placement of large surface cuff electrodes, which was refined by the introduction of functional nerve mapping with circumferential electrical stimulation. This substantially improved the targeting of sensory fascicles. Surgical placement of spinal cord stimulation (SCS) “button type” paddle electrodes was replaced when the introduction of percutaneous cylindrical SCS electrodes expanded the spectrum of PNS applications and improved the ability to target afferent sensory fibers as well as reducing the complication rate. To further refine functional mapping for the placement of these percutaneous electrodes, radiofrequency needle probes have more recently been employed to elicit paresthesias in awake patients to map the pain generators and guide treatment. In this chapter, we provide a description of the development and basic mechanisms of peripheral nerve stimulation, as well as a more detailed description of the two most commonly employed forms of peripheral nerve stimulation: occipital nerve stimulation for occipital neuralgia, and subcutaneous peripheral nerve field stimulation (PNfS) to stimulate free nerve endings within the subcutaneous tissue when the pain is limited to a small, well-localized area. The closely related ideas of internal and external targeted subcutaneous stimulation are also discussed.
	10	+
	11	+= Index of Sections =
	12	+
	13	+Section 7.1: Introduction to Peripheral Neurostimulation
	14	+Section 7.2: Anatomy and Physiology
	15	+Section 7.3: Percutaneous Surgical Techniques
	16	+Section 7.4: Discussion and Conclusion
	17	+
10	10	= Abstract =
11	11
12	12	Since its inception in the 1970s, peripheral neuromodulation has become an increasingly common procedure to treat chronic neuropathic disorders. Historically, peripheral nerve stimulation (PNS) originated with the placement of large surface cuff electrodes, which was refined by the introduction of functional nerve mapping with circumferential electrical stimulation. This substantially improved the targeting of sensory fascicles. Surgical placement of spinal cord stimulation (SCS) “button type” paddle electrodes was replaced when the introduction of percutaneous cylindrical SCS electrodes expanded the spectrum of PNS applications and improved the ability to target afferent sensory fibers as well as reducing the complication rate. To further refine functional mapping for the placement of these percutaneous electrodes, radiofrequency needle probes have more recently been employed to elicit paresthesias in awake patients to map the pain generators and guide treatment. In this chapter, we provide a description of the development and basic mechanisms of peripheral nerve stimulation, as well as a more detailed description of the two most commonly employed forms of peripheral nerve stimulation: occipital nerve stimulation for occipital neuralgia, and subcutaneous peripheral nerve field stimulation (PNfS) to stimulate free nerve endings within the subcutaneous tissue when the pain is limited to a small, well-localized area. The closely related ideas of internal and external targeted subcutaneous stimulation are also discussed.