Study record managers: refer to the Data Element Definitions if submitting registration or results information. Subjects will be randomized at enrollment into either a delayed or immediate continuation group. The immediate continuation group will immediately continue with the stimulation after a day trial period and will be monitored for a total of 12 months. The delayed activation group will have their device turned off after the day trial period for the next 3-months. At the 3-month visit, both groups be evaluated and the delayed activation group will have their devices reactivated. Subjects will have neuropathic pain of various etiologies, including trauma, surgery or post-herpetic infections.
Train Of Four Monitoring
Facial nerve | Radiology Reference Article | richardpochinko.com
Peripheral nerve stimulation PNS is an excellent and robust modality for the treatment of chronic or refractory neuropathic pain. Its use differs from spinal cord stimulation SCS in that it is more specific: it is easier to target small watersheds of neuropathic pain, and it does not violate the CNS, but it does require a robust understanding of peripheral neuroanatomy and the techniques and tools used to implant in the periphery. Two subtypes of PNS exist: direct PNS stimulation of a peripheral nerve and peripheral nerve field stimulation PNfS where the target is the terminal, sensory, cutaneous nerve fibers in a local area. Generally speaking, PNS is warranted when following circumstances exist: 1 SCS is unsuitable for any reason, such as the central neuro-axis is difficult to access or alterations and coagulation are unmitigatable, or 2 a situation better suits peripheral nerve stimulation than SCS. Those situations are nuanced. Often times, direct nerve trauma and the resulting painful conditions such as CRPS type II or causalgia responds very robustly to direct stimulation of the peripheral nerve proximal to the injury.
Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain TNP is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication carbamazepine, phenytoin, gabapentin, etc. TNP, however, can be a condition difficult to adequately treat with medical management alone.
Vagus nerve stimulation involves the use of a device to stimulate the vagus nerve with electrical impulses. An implantable vagus nerve stimulator is currently FDA-approved to treat epilepsy and depression. There's one vagus nerve on each side of your body, running from your brainstem through your neck to your chest and abdomen. In conventional vagus nerve stimulation, a device is surgically implanted under the skin on your chest, and a wire is threaded under your skin connecting the device to the left vagus nerve.