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Samuel J. Hassenbusch, Michael Stanton-Hicks, Derek Schoppa, James G. Walsh and Edward C. Covington

M any patients diagnosed with reflex sympathetic dystrophy (RSD) 2, 11 or complex regional pain syndrome (CRPS) according to the most recent taxonomy 21, 34 can be treated successfully with medications, blocks, or infusions. 3, 14, 29, 32 In approximately 50% to 70% of patients with severe RSD, electrical stimulation of the spinal cord is reported to be effective in treating pain, vasomotor changes, and trophic changes. 1, 4, 31 Peripheral nerve stimulation (PNS) is another modality that has been described in the treatment of severe RSD. 16, 17, 25

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Combined epidural and peripheral nerve stimulation for relief of pain

Description of technique and preliminary results

Bruno J. Urban and Blaine S. Nashold Jr.

accurately. The ligamentum flavum should be pierced just after the midline has been passed. Thus, the tip of the needle comes to rest within the epidural space of the painful side, pointing caudad and laterally ( Fig. 1 right ). As with the conventional technique, the epidural space is identified by the negative pressure and loss of resistance encountered. 2 Fig. 2. Case 10. Radiograph, anterolateral (left) and lateral (right) views, illustrating the position of the electrodes after a combined epidural-peripheral nerve stimulator implantation procedure

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James N. Campbell and Donlin M. Long

. 8, 15, 16 A third method of neural stimulation for pain control involves implantation of peripheral nerve stimulators (PNS). Bipolar electrodes are attached to major nerves of which the field of innervation contains the region in which pain arises, and are then connected to a radiofrequency receiver placed under the skin. The electrodes can then be activated by a transmitting device connected to an antenna taped in place over the receiver. In the following report, we describe the results obtained in a series of 23 patients who have undergone implantation of

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Blaine S. Nashold Jr., John B. Mullen and Roger Avery

I n 1965, White and Sweet 1, 6 implanted a pair of Silastic split-ring platinum electrodes around the ulnar and median nerves in a woman with intractable burning pain in the left hand. Stimulation of the median nerve resulted in a pleasant tingling sensation in the first three fingers with relief of her pain. Since then, other reports have appeared of satisfactory long-term pain relief from peripheral nerve stimulation. 2, 3, 5 The cuff-type electrode has been used extensively and, although it does satisfactorily stimulate the nerve, Nielson, et al. , 4

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Neurosurgical forum: Letters to the editor To The Editor Blaine S. Nashold , Jr. , M.D. Durham, North Carolina 132 133 I am writing to comment on the recent paper by Drs. Law, Swett, and Kirsch on peripheral nerve stimulation for chronic pain (Law JD, Swett J, Kirsch WM: Retrospective analysis of 22 patients with chronic pain treated by peripheral nerve stimulation. J Neurosurg 52: 482–485, April, 1980). Law and his colleagues have a great deal of experience with the technique, but I believe that a neurosurgeon

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Jay D. Law, John Swett and Wolff M. Kirsch

tranquilizers, diphenylhydantoin, and carbamazepine. In most patients, surgical treatments such as sympathectomy (or diagnostic sympathetic block), neurolysis, and neurectomy were performed in preference to peripheral nerve stimulation. These procedures did not succeed in these patients, so peripheral nerve stimulation was recommended. No patient had undergone a rhizotomy, or any more central pain procedure. An important screening procedure consisted chiefly of consultation with our multidisciplinary pain clinic, patterned on the recommendations of Greenhoot and Sternbach

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Chandan G. Reddy, Oliver E. Flouty, Marshall T. Holland, Leigh A. Rettenmaier, Mario Zanaty and Foad Elahi

C hronic neuropathic pain is challenging to treat. For patients in whom maximal medical therapy has failed, peripheral nerve stimulation (PNS) is a potential alternative. 6 Though PNS techniques and their results have been described for several decades, 25 many insurance carriers have recently deemed PNS an experimental procedure relative to other modes of neuromodulation such as spinal cord stimulation (SCS) and deep brain stimulation (DBS). Much like other methods of neuromodulation, however, the mechanisms of action of PNS are not completely

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Kelly Ishizuka, Anne Louise Oaklander and E. Antonio Chiocca

different location, patients reported far greater relief of pain. Discussion The first nerve stimulator was implanted to treat chronic pain in 1967. 18 The rate of success of peripheral nerve stimulation averages 60% across most studies. 7 These success rates are comparable to those for pharmacotherapy and are slightly higher than those reported for dorsal column stimulation, a much more commonly performed procedure. 11 Because patients undergoing this surgery have tried more conservative measures that have failed to adequately relieve pain, the significant pain

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Bengt H. Sjölund

, Giesler GJ Jr , Besson JM : An analysis of response properties of spinal cord dorsal horn neurones to nonnoxious and noxious stimuli in the spinal rat. Exp Brain Res 27 : 15 – 33 , 1977 Menétrey D, Giesler GJ Jr, Besson JM: An analysis of response properties of spinal cord dorsal horn neurones to nonnoxious and noxious stimuli in the spinal rat. Exp Brain Res 27: 15–33, 1977 14. Picaza JA , Cannon BW , Hunter SE , et al : Pain suppression by peripheral nerve stimulation. Part I. Observations with

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Peripheral nerve stimulation suppression of C-fiber-evoked flexion reflex in rats

Part 2: Parameters of low-rate train stimulation of skin and muscle afferent nerves

Bengt H. Sjölund

relation to a flexion reflex. J Neurophysiol 50: 1108–1121, 1983 18. Sjölund BH : Peripheral nerve stimulation suppression of C-fiber-evoked flexion reflex in rats. Part I: Parameters of continuous stimulation. J Neurosurg 63 : 612 – 616 , 1985 Sjölund BH: Peripheral nerve stimulation suppression of C-fiber-evoked flexion reflex in rats. Part I: Parameters of continuous stimulation. J Neurosurg 63: 612–616, 1985 19. Sjölund BH , Eriksson MBE : The influence of naloxone on analgesia produced by peripheral