Novel High‐Frequency Peripheral Nerve Stimulator Treatment of Refractory Postherpetic Neuralgia: A Brief Technical Note. Issue 6 (1st April 2015)

• Record Type: Journal Article
• Authors: Lerman, Imanuel R.; Chen, Jeffrey L.; Hiller, David; Souzdalnitski, Dmitri; Sheean, Geoffrey; Wallace, Mark; Barba, David
• Is Part Of: Neuromodulaton. Volume 18:Issue 6(2015:Nov./Dec.)
• Page Start: 487
• Page End: 493
• Publication Date: 2015-04-01
• Subjects: Central nervous system -- Physiology -- Periodicals; Central nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ner.12281
• Languages: English
• ISSNs: 1094-7159

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ner12281-sec-0001" sec-type="section"> <title>Objectives</title> <p>The study aims to describe an ultrasound (US)‐guided peripheral nerve stimulation implant technique and describe the effect of high‐frequency peripheral nerve stimulation on refractory postherpetic neuralgia.</p> </sec> <sec id="ner12281-sec-0002" sec-type="section"> <title>Materials and Methods</title> <p>Following a cadaver pilot trial using US and confirmatory fluoroscopic guidance, a 52‐year‐old man with refractory left supraorbital neuralgia underwent combined US and fluoroscopic‐guided supraorbital peripheral nerve stimulator trial. The patient was subsequently implanted with a percutaneous lead over the left supraorbital and supratrochlear nerve utilizing a high‐frequency stimulation paradigm.</p> </sec> <sec id="ner12281-sec-0003" sec-type="section"> <title>Results</title> <p>At 9 months follow‐up, the pain intensity had declined from a weekly average of 8/10 to 1/10 on the pain visual analog scale (VAS). After implant, both nerve conduction and blink reflex studies were performed, which demonstrated herpetic nerve damage and frequency‐specific peripheral nerve stimulation effects. The patient preferred analgesia in the supraorbital nerve distribution accomplished with high‐frequency paresthesia‐free stimulation (HFS) at an amplitude of 6.2 mA, a frequency of 100–1200 Hz, and a pulse width of 130 μsec, to paresthesia‐mediated pain relief associated with low‐frequency stimulation.</p> </sec> <sec id="ner12281-sec-0004" sec-type="section"> <title>Conclusion</title> <p>We report the implant of a supraorbital peripheral nerve stimulating electrode that utilizes a high‐frequency program resulting in sustained suppression of intractable postherpetic neuralgia.</p> </sec> </abstract>