Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Saper JR, Dodick DW, Silberstein SD, et al. Stimulation of the greater occipital nerve: anatomical considerations and clinical implications. Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Peripheral nerve stimulation inhibits nociceptive processing: an electrophysiological study in healthy volunteers. This important study demonstrates that the mechanism of action in peripheral nerve stimulation with subcutaneous leads differs from and may be more effective than TENS.Įllrich J, Lamp S. Differential Effects of Subcutaneous Electrical Stimulation (SQS) and Transcutaneous Electrical Nerve Stimulation (TENS) in Rodent Models of Chronic Neuropathic or Inflammatory Pain. Vera-Portocarrero LP, Cordero T, Billstrom T, et al. Effect of transcutaneous electrotherapy on CSF β-endorphin content in patients without pain problems. Effect of low and high frequency TENS on met-enkephalin-arg-phe and dynorphin A immunoreactivity in human lumbar CSF. Development of opioid tolerance with repeated transcutaneous electrical nerve stimulation administration. Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electric nerve stimulation in rats with joint inflammation. Release of GABA and activation of GABA A receptors in the spinal cord mediates the effects of TENS in rats. Blockade of spinal 5-HT receptor subtypes prevents low, but not high, frequency TENS-induced antihyperalgesia in rats. Radhakrishnan R, King EW, Dickman J, et al. Spinal muscarinic receptors are activated during low or high frequency TENS-induced antihyperalgesia in rats. Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS). Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. Effect of electrical stimulation of peripheral nerves on neuropathic pain. Long-term potentiation and long-term depression of primary afferent neurotransmission in the rat spinal cord. Low-frequency stimulation of afferent Adelta-fibers induces long-term depression at primary afferent synapses with substantia gelatinosa neurons in the rat. Sandkühler J, Chen JG, Cheng G, Randić M. Direct effect of electrical stimulation on peripheral nerve evoked activity: Implications in pain relief. Spinal cord stimulation: a brief update on mechanism of action. Spinal cord stimulation: exploration of the physiological basis of a widely used therapy. Neuromodulation Technol Neural Interface. Peripheral neurostimulation for control of intractable occipital neuralgia. Papers of particular interest, published recently, have been highlighted as: A noninvasive stimulation will open this treatment modality to more clinicians of varying backgrounds. New technologies that allow easier and safer electrode placement are expected to further expand the uses of PNS. The use of PNS in modulating organ function in treatment of syndromes such as epilepsy, incontinence and obesity with vagal, tibial and gastric stimulation is under extensive investigation. It has been expanded into other individual nerves or nerve plexuses to treat neuropathic, visceral, cardiac, abdominal, low back and facial pain. Cylindrical leads were implanted to stimulate the greater occipital nerve to manage intractable headache. The first percutaneous peripheral nerve stimulators were reported in 1999. However, it is currently commonplace to use percutaneous leads, as this approach has become instrumental in its expansion. The first implantable systems were surgically placed. Its expansion has become possible due to both technological and clinical advances in pain medicine. Peripheral nerve stimulation (PNS) is likely the most diverse and rapidly expanding area of neuromodulation.
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