Bénédicte Bouche1, Marie Manfiotto2, Philippe Rigoard3,4, Jean Lemarie5, Véronique Dix-Neuf5, Michel Lanteri-Minet6,7,8, Denys Fontaine2,7. 1. Pain Clinic, Clinique Saint Léonard Village Santé, Trélazé, France. 2. Department of Neurosurgery, CHU de Nice, Nice, France. 3. Spine & Neuromodulation Unit, Department of Neurosurgery, Poitiers University Hospital, Poitiers, France. 4. PRISMATICS Lab, Predictive Research In Spine Management/Neuromodulation & Thoracic Innovations/Cardiac Surgery Lab, Poitiers University Hospital, Poitiers, France. 5. Pain Clinic, Clinique Bretéché, Nantes, France. 6. Pain Department, CHU de Nice, Nice, France. 7. Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte-d'Azur, Nice, France. 8. INSERM/UdA, U1107, Neuro-Dol, Université d'Auvergne, Clermont-Ferrand, France.
Abstract
OBJECTIVES: We report the outcome of a consecutive series of 26 patients suffering from chronic medically-refractory neuropathic pain of the upper limb (including 16 patients with complex regional pain syndrome), topographically limited, treated by brachial plexus (BP) nerve roots or supra-scapular nerve (SSN) peripheral nerve stimulation (PNS). MATERIALS AND METHODS: The technique consisted in ultrasound-guided percutaneous implantation of a cylindrical lead (Pisces-Quad, Medtronic) close to the SSN or the cervical nerve roots within the BP, depending on the pain topography. All the patients underwent a positive trial stimulation before lead connection to a subcutaneous stimulator. Chronic bipolar stimulation mean parameters were: frequency 55.5 Hertz, voltage 1.17 Volts. The voltage was set below the threshold inducing muscle contractions or paresthesias. RESULTS: Two patients were lost immediately after surgery. At last follow-up (mean 27.5 months), the 20 patients still using the stimulation experienced a mean pain relief of 67.1%. Seventeen patients were improved ≥50%, including 12 improved ≥70%. In 11 patients with a follow-up >2 years, the mean pain relief was 68%. At last follow-up, respectively, six out of the nine (67%) patients treated by SSN stimulation and 10 out of 17 patients (59%) treated by BP stimulation were improved ≥50%. At last follow-up, 12 out of 20 patients still using the stimulation were very satisfied, six were satisfied, and two were poorly satisfied. Complications were: stimulation intolerance due to shock-like sensations (three cases), superficial infection (1), lead fractures (2), and migration (1). CONCLUSION: In this pilot study, SSN or BP roots PNS provided a relatively safe, durable and effective option to control upper limb neuropathic pain.
OBJECTIVES: We report the outcome of a consecutive series of 26 patients suffering from chronic medically-refractory neuropathic pain of the upper limb (including 16 patients with complex regional pain syndrome), topographically limited, treated by brachial plexus (BP) nerve roots or supra-scapular nerve (SSN) peripheral nerve stimulation (PNS). MATERIALS AND METHODS: The technique consisted in ultrasound-guided percutaneous implantation of a cylindrical lead (Pisces-Quad, Medtronic) close to the SSN or the cervical nerve roots within the BP, depending on the pain topography. All the patients underwent a positive trial stimulation before lead connection to a subcutaneous stimulator. Chronic bipolar stimulation mean parameters were: frequency 55.5 Hertz, voltage 1.17 Volts. The voltage was set below the threshold inducing muscle contractions or paresthesias. RESULTS: Two patients were lost immediately after surgery. At last follow-up (mean 27.5 months), the 20 patients still using the stimulation experienced a mean pain relief of 67.1%. Seventeen patients were improved ≥50%, including 12 improved ≥70%. In 11 patients with a follow-up >2 years, the mean pain relief was 68%. At last follow-up, respectively, six out of the nine (67%) patients treated by SSN stimulation and 10 out of 17 patients (59%) treated by BP stimulation were improved ≥50%. At last follow-up, 12 out of 20 patients still using the stimulation were very satisfied, six were satisfied, and two were poorly satisfied. Complications were: stimulation intolerance due to shock-like sensations (three cases), superficial infection (1), lead fractures (2), and migration (1). CONCLUSION: In this pilot study, SSN or BP roots PNS provided a relatively safe, durable and effective option to control upper limb neuropathic pain.
Authors: Natalie Strand; Ryan S D'Souza; Jonathan M Hagedorn; Scott Pritzlaff; Dawood Sayed; Nomen Azeem; Alaa Abd-Elsayed; Alexander Escobar; Mark A Huntoon; Christopher M Lam; Timothy R Deer Journal: J Pain Res Date: 2022-08-23 Impact factor: 2.832
Authors: Blanca De-la-Cruz-Torres; Vanesa Abuín-Porras; Emmanuel Navarro-Flores; César Calvo-Lobo; Carlos Romero-Morales Journal: Int J Environ Res Public Health Date: 2021-05-03 Impact factor: 3.390