| r |
One of the main functions of peripheral nerves is to communicate signals from the periphery to the spinal cord to the brain
and the rest of the body.
Peripheral neuropathy is a disorder involving the peripheral nervous system (PNS). The central nervous system (CNS)
includes your brain and spinal cord. The PNS includes all of the nerves from your spinal cord to the rest of your body.
Peripheral neuropathy can be caused by many conditions including vitamin deficiencies, alcoholism, autoimmune
diseases, certain medications, trauma, unknown causes, and diabetes. When your peripheral nerves become damaged,
they do not function properly, and can eventually produce symptoms of pain, tingling, or numbness.
The syndromes that may benefit from Peripheral Nerve or Field Stimulation include:
• Complex Regional Pain Syndrome
• Diabetic Peripheral Neuropathy
• Lateral Femoral Cutaneous Neuropathy
• Back and Neck Pain
• Post-Surgical Pain
• Occipital Neuralgia
• Trigeminal Neuralgia
• Traumatic Nerve Injuries
• Peripheral Vascular Disease Neuropathy
• Post-amputation Pain
• Herpetic Neuralgia
• Trigeminal Neuralgia
• Reflex Sympathetic Dystrophy (RSD)
• Complex Regional Pain Syndrome (CRPS)
• Refractory Angina
• Other conditions that have failed conventional therapies.
Procedure:
Peripheral Nerve or Field Stimulation uses an innovative technology that works by introducing an electrical current to the
source of chronic pain. Under local anesthetic (numbing agent) and IV sedation your pain physician will place a
stimulator lead along the painful nerves. Patients typically undergo a trial for 7 days to see if they feel better and have
increased activity with the device. If pain improves, a permanent electrode and battery can be placed.
If the permanent device is place, soft thin wires with electrical leads on their tips are placed through a needle under the
skin. A small incision is made and the battery is placed under the skin. This device is turned on and releases electrical
stimulation to the affected nerves. You pain will be replaced by a tingle instead of the pain originally felt.
The entire procedure takes less than a couple of hours to complete, and is done as an outpatient. The stimulator is so
small that you can wear bathing suits and continue normal activities without an inconvenience. The stimulator is not
visible and lies under the skin. It is a self-contained system much like a pace-maker.
Benefits:
The implanted device produces a low voltage current which creates a sensation that blocks the brain’s ability to sense the
previously perceived pain. It interferes with the perception of pain by creating a pleasant sensation that replaces the
pain. The intensity of the stimulator can be changed, and the system can be turned on and off as necessary to provide
optimal pain relief as experienced by the patient.
Treatment of chronic neuropathic pain in the region of the face, neck, and head are challenging for pain specialists to
treat. The pain is typically refractory to many of the conventional treatment options. Recently peripheral nerve
stimulation has become increasing common in difficult to treat neuropathic facial pain.
Risks:
Most peripheral nerve stimulation procedures are performed on an outpatient basis. As expected with any surgical
procedure, there are potential risks. Side effects that may occur include bleeding, infection, scar tissue deposition,
electrode failure, inadequate pain surface area coverage, and nerve damage. While the incision is healing it is important
to keep it dry and clean so an infection does not occur. If there is any drainage or redness at the site then you may have
developed an infection and your pain specialist must evaluate you.
Patients with the following conditions should not receive peripheral nerve stimulation and should talk to their pain
specialist about other options:
• Cardiac pacemaker
• Systemic infection
• Pregnancy or lactating
Outcomes:
Peripheral nerve stimulation is reported to be an effective pain treatment by the inhibition of nociception (pain perception)
and pain from the peripheral nervous system (Ristic 2007). In a clinical investigation of patients receiving peripheral
nerve stimulation for craniofacial pain, 73% of the patients experienced significant improvement in pain intensity
(Konstantin 2006). With the improvement of pain symptoms after treatment, you may be able to decrease pain
medications and increase your daily activities.
The number of centers using peripheral nerve stimulation for craniofacial pain and other peripheral nerve syndromes is
increasing. In the future there will be a wider acceptance of this treatment because it is minimally invasive, can be tested,
is reversible in effect, and has adjustable settings. These unique qualities may eventually make peripheral nerve
stimulation the preferred modality for otherwise intractable conditions (Konstantin 2006).
Peripheral nerve stimulation can be very effective in reducing chronic pain from certain painful conditions, however it does
not work for everyone. A trial with a temporary device is usually done before you have a permanent device placed, which
ensures good response to therapy. For those that it does help it is an innovative treatment that brings significant relief.
You should contact Arizona Pain Specialists now to speak with a physician to see if this treatment can benefit you. We are
happy to offer this service as a pain management tool for patients in the Phoenix area.
Journal Articles:
Trigeminal and Occipital Peripheral Nerve Stimulation for Craniofacial Pain: A Single-institution Experience and Review of
the Literature Konstantin V. Slavin, M.D.; M. Efkan Colpan, M.D.; Naureen Munawar, M.D.; Christian Wess, M.D.; Hrachya
Nersesyan, M.D., Ph.D. Neurosurg Focus. 2006;21(6) 2006 American Association of Neurological Surgeons
Analgesic and antinociceptive effects of peripheral nerve neurostimulation in an advanced human experimental model.
Ristić D, Spangenberg P, Ellrich J. Eur J Pain. 2007 Sep 17
and the rest of the body.
Peripheral neuropathy is a disorder involving the peripheral nervous system (PNS). The central nervous system (CNS)
includes your brain and spinal cord. The PNS includes all of the nerves from your spinal cord to the rest of your body.
Peripheral neuropathy can be caused by many conditions including vitamin deficiencies, alcoholism, autoimmune
diseases, certain medications, trauma, unknown causes, and diabetes. When your peripheral nerves become damaged,
they do not function properly, and can eventually produce symptoms of pain, tingling, or numbness.
The syndromes that may benefit from Peripheral Nerve or Field Stimulation include:
• Complex Regional Pain Syndrome
• Diabetic Peripheral Neuropathy
• Lateral Femoral Cutaneous Neuropathy
• Back and Neck Pain
• Post-Surgical Pain
• Occipital Neuralgia
• Trigeminal Neuralgia
• Traumatic Nerve Injuries
• Peripheral Vascular Disease Neuropathy
• Post-amputation Pain
• Herpetic Neuralgia
• Trigeminal Neuralgia
• Reflex Sympathetic Dystrophy (RSD)
• Complex Regional Pain Syndrome (CRPS)
• Refractory Angina
• Other conditions that have failed conventional therapies.
Procedure:
Peripheral Nerve or Field Stimulation uses an innovative technology that works by introducing an electrical current to the
source of chronic pain. Under local anesthetic (numbing agent) and IV sedation your pain physician will place a
stimulator lead along the painful nerves. Patients typically undergo a trial for 7 days to see if they feel better and have
increased activity with the device. If pain improves, a permanent electrode and battery can be placed.
If the permanent device is place, soft thin wires with electrical leads on their tips are placed through a needle under the
skin. A small incision is made and the battery is placed under the skin. This device is turned on and releases electrical
stimulation to the affected nerves. You pain will be replaced by a tingle instead of the pain originally felt.
The entire procedure takes less than a couple of hours to complete, and is done as an outpatient. The stimulator is so
small that you can wear bathing suits and continue normal activities without an inconvenience. The stimulator is not
visible and lies under the skin. It is a self-contained system much like a pace-maker.
Benefits:
The implanted device produces a low voltage current which creates a sensation that blocks the brain’s ability to sense the
previously perceived pain. It interferes with the perception of pain by creating a pleasant sensation that replaces the
pain. The intensity of the stimulator can be changed, and the system can be turned on and off as necessary to provide
optimal pain relief as experienced by the patient.
Treatment of chronic neuropathic pain in the region of the face, neck, and head are challenging for pain specialists to
treat. The pain is typically refractory to many of the conventional treatment options. Recently peripheral nerve
stimulation has become increasing common in difficult to treat neuropathic facial pain.
Risks:
Most peripheral nerve stimulation procedures are performed on an outpatient basis. As expected with any surgical
procedure, there are potential risks. Side effects that may occur include bleeding, infection, scar tissue deposition,
electrode failure, inadequate pain surface area coverage, and nerve damage. While the incision is healing it is important
to keep it dry and clean so an infection does not occur. If there is any drainage or redness at the site then you may have
developed an infection and your pain specialist must evaluate you.
Patients with the following conditions should not receive peripheral nerve stimulation and should talk to their pain
specialist about other options:
• Cardiac pacemaker
• Systemic infection
• Pregnancy or lactating
Outcomes:
Peripheral nerve stimulation is reported to be an effective pain treatment by the inhibition of nociception (pain perception)
and pain from the peripheral nervous system (Ristic 2007). In a clinical investigation of patients receiving peripheral
nerve stimulation for craniofacial pain, 73% of the patients experienced significant improvement in pain intensity
(Konstantin 2006). With the improvement of pain symptoms after treatment, you may be able to decrease pain
medications and increase your daily activities.
The number of centers using peripheral nerve stimulation for craniofacial pain and other peripheral nerve syndromes is
increasing. In the future there will be a wider acceptance of this treatment because it is minimally invasive, can be tested,
is reversible in effect, and has adjustable settings. These unique qualities may eventually make peripheral nerve
stimulation the preferred modality for otherwise intractable conditions (Konstantin 2006).
Peripheral nerve stimulation can be very effective in reducing chronic pain from certain painful conditions, however it does
not work for everyone. A trial with a temporary device is usually done before you have a permanent device placed, which
ensures good response to therapy. For those that it does help it is an innovative treatment that brings significant relief.
You should contact Arizona Pain Specialists now to speak with a physician to see if this treatment can benefit you. We are
happy to offer this service as a pain management tool for patients in the Phoenix area.
Journal Articles:
Trigeminal and Occipital Peripheral Nerve Stimulation for Craniofacial Pain: A Single-institution Experience and Review of
the Literature Konstantin V. Slavin, M.D.; M. Efkan Colpan, M.D.; Naureen Munawar, M.D.; Christian Wess, M.D.; Hrachya
Nersesyan, M.D., Ph.D. Neurosurg Focus. 2006;21(6) 2006 American Association of Neurological Surgeons
Analgesic and antinociceptive effects of peripheral nerve neurostimulation in an advanced human experimental model.
Ristić D, Spangenberg P, Ellrich J. Eur J Pain. 2007 Sep 17
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Peripheral Nerve or Field Stimulation
by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch M.D
Peripheral Nerve or Peripheral Field Stimulation procedures are
becoming increasingly popular for the treatment of many causes
of nerve related pain and peripheral neuralgias. This
revolutionary treatment works by placing electrodes along the
course of painful peripheral nerves to control pain. The
stimulation blocks pain perception from traveling from the nerve to
the brain. It involves a small device that is placed near the
involved nerve that delivers low-level electrical impulses that
interfere with the perception of pain, especially chronic nerve pain.
by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch M.D
Peripheral Nerve or Peripheral Field Stimulation procedures are
becoming increasingly popular for the treatment of many causes
of nerve related pain and peripheral neuralgias. This
revolutionary treatment works by placing electrodes along the
course of painful peripheral nerves to control pain. The
stimulation blocks pain perception from traveling from the nerve to
the brain. It involves a small device that is placed near the
involved nerve that delivers low-level electrical impulses that
interfere with the perception of pain, especially chronic nerve pain.
Book I - Pain Syndromes
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions