Neurostimulation Techniques for Painful Peripheral Nerve Disorders

Disorders of the peripheral nervous system often present a unique challenge to the clinician or surgeon, because the neuropathic pain associated with them can be extremely resistant to typical pain treatments. Painful peripheral nerve disorders often have pain in a particular peripheral nerve distribution, and thus an optimal treatment modality is one that delivers targeted relief to the precise distribution of the pain. To that end, peripheral nerve stimulation (PNS) has undergone several refinements in recent years. New types of stimulation, such as techniques for cranial nerve stimulation and spinal nerve root stimulation (SNRS), have enabled the treatment of painful peripheral nerve problems that until fairly recently were either untreatable or poorly treated with traditional spinal cord stimulation (SCS) techniques. In this article, PNS techniques are described in detail for the stimulation of the occipital and trigeminal nerves for intractable craniofacial pain, as well as emerging techniques for the selective stimulation of spinal nerve roots and subcutaneous peripheral nerve stimulation. The increasing spectrum of disorders and pain syndromes amenable to PNS also is discussed.