Neuromodulation

[mehul_25]

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We do quite a bit of neuromodulation here at our program, particularly lumbar and cervical SCS and occipital stimulation. I was wondering if anyone had a good reference for Peripheral stimulation and/or different techniques for stimulation (i.e. retrograde placement). Might I even suggest putting a "primer" on stimulation together?

 

[Aether2000]

Peripheral nerve stimulation can only be performed for specific nerves that have demonstrated lesions causing dysfunction specifically in the distribution of the nerve. These are confirmed through use of EMG. Use of peripheral nerve stimulators for generalized low back pain, myofascial pain in a non-peripheral nerve distribution, or other uses without a specific identified nerve may be viewed by insurance companies as insurance fraud, so it would be wise to veer far away from this very dangerous course. Peripheral nerve stimulation should not be used as a $40,000 TENS unit....

 

[mille125]

as usual...i agree with algos

 

[Mister Mxyzptlk]

I just implant sterile TENS unit pads under the skin and connect them to an inductive coil antenna salvaged from a old Mattrix system. You can find the Mattirx systems on eBay. It requires some soldering. 🙂

 

[Aether2000]

LOL! On my way to Radio Shack to buy a solder gun...

 

[lobelsteve]

We have had unusual results with peripheral field stimulation.

Unusual for 2 reasons:

1. It works for a large number of our patients (works= 70% or better pain relief over the 1 week trial)

2. Insurance is paying for it for now.

We do not do any peripheral nerve stimulation except rarely. These cases include the suprascapular nerve in the notch and the zygomatic branch of the V2 nerve. Nothing like a 14G Tuohy in the face.

 

[Mister Mxyzptlk]

Are you doing your suprascapular implants percutaneously or are you putting in paddle leads? Seems like a very mobile area for a perc lead implant.

 

[PainDr]

Peripheral nerve stimulation can only be performed for specific nerves that have demonstrated lesions causing dysfunction specifically in the distribution of the nerve. These are confirmed through use of EMG.

Algos, what about occipital nerve stimulation. Is that an exception?

We have had unusual results with peripheral field stimulation

Steve, could you elaborate? Maybe I'm just a pinhead, but I'm not familiar with that term.

 

[mehul_25]

Algos, what about occipital nerve stimulation. Is that an exception?




Steve, could you elaborate? Maybe I'm just a pinhead, but I'm not familiar with that term.

We are actually involved with clinical trials for occipital nerve stimulation for headaches with ANS. We have definitely had some good success with it.

 

[Aether2000]

Occipital nerve stimulation is just that...stimulation of a nerve that has a specific nerve distribution, and it is a modestly well accepted procedure. What is highly questionable and fraud is sticking these leads subcutaneously nowhere near the distribution of a specific nerve and just stimulating whatever. This is a $40,000 TENS unit. No insurer should be deceived by fraudulant coding to coerce them into paying for such nonsense...

 

[Disciple]

Peripheral nerve stimulation can only be performed for specific nerves that have demonstrated lesions causing dysfunction specifically in the distribution of the nerve. These are confirmed through use of EMG.

Are these insurance requirements/criteria?

I'm not sure how EMG/NCS could be done for for Occip Nerve stim, or as Steve lists above, stim for the V2 Zygomatic branch.

 

[ParaVert]

Somebody told me that they heard of someone stimulating the Gasserian ganglion via a perc lead placed through the foramen ovale. Anybody done this? I've heard of stimulating the trigeminal tract via an epidural stim placed at C1-2, but not this.

I'm comfortable with Gasserian blocks and RF, but am afraid of dolorosa and would like to use this technique if it turns out to be technically feasable.

 

[Aether2000]

Anchoring would be a nightmare and tunneling would not be much fun either...
Perhaps we could devise a way to anchor it to their gumline...

 

[ParaVert]

What about using a Medtronic Interstim lead with self-anchoring tines? That should eliminate at least one problem...

 

[Ligament]

I believe Raj's atlas has a picture of this...I have read about this technique in print somewhere, cant pinpoint it right now. I did not have to look very hard to find it so a medline search should find something for you pretty fast.

Somebody told me that they heard of someone stimulating the Gasserian ganglion via a perc lead placed through the foramen ovale. Anybody done this? I've heard of stimulating the trigeminal tract via an epidural stim placed at C1-2, but not this.

I'm comfortable with Gasserian blocks and RF, but am afraid of dolorosa and would like to use this technique if it turns out to be technically feasable.