Oscar A. de Leon-Casasola, MD Journal of Pain and Symptom Management

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Presentation transcript:

Spinal Cord and Peripheral Nerve Stimulation Techniques for Neuropathic Pain Oscar A. de Leon-Casasola, MD Journal of Pain and Symptom Management Volume 38, Issue 2, Pages S28-S38 (August 2009) DOI: 10.1016/j.jpainsymman.2009.05.005 Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 1 Epidural spinal cord stimulation lead placement for vulvar pain. Note that the physiologic midline differs from the anatomic midline. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 2 Epidural spinal cord stimulation lead placement for post-thoracotomy pain syndrome. Note that one lead is used for anterior chest pain (medial lead), and the other for lateral and posterior chest pain (lateral lead). Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 3 Epidural spinal cord stimulation lead placement for postmastectomy pain syndrome. Note that one lead is used for axillary and lateral chest pain (medial lead), and the other for medial arm pain (lateral lead). Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 4 Epidural spinal cord stimulation lead placement for lower-extremity pain associated with chemotherapy-induced peripheral neuropathy. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 5 Epidural spinal cord stimulation lead placement for foot pain. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 6 Epidural spinal cord stimulation lead placement for foot pain nonresponsive to traditional placement as shown in Fig. 5. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 7 Subcutaneous lead placement for lesser occipital nerve stimulation in a patient with postcraniotomy pain syndrome. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 8 Subcutaneous lead placement for supra-trochlear and supraorbital nerve stimulation in a patient with post-eye enucleation pain syndrome. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 9 Subcutaneous lead placement for infraorbital nerve stimulation in a patient with pain after excision of a basal cell carcinoma of the face. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 10 Migration of subcutaneous lead to the infraclavicular region in a patient who was treated for lesser occipital nerve injury. The patient is an avid swimmer and experienced loss of stimulation after a prolonged swimming session. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 11 Subcutaneous lead placement for superficial cervical plexus injury after a modified radical neck dissection. The patient experienced symptoms that suggested both greater auricular nerve and transverse nerve injury. Hence, a lead with eight contacts was chosen and the tip of the lead was placed at the angle of the mandible. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 12 Subcutaneous lead placement for both genitofemoral (superior lead) and ilioinguinal (inferior lead) nerve injuries after orchiectomy. The horizontal line shows the site of the incision, and the vertical lines show the medial and lateral boundaries of the incision. Journal of Pain and Symptom Management 2009 38, S28-S38DOI: (10.1016/j.jpainsymman.2009.05.005) Copyright © 2009 U.S. Cancer Pain Relief Committee Terms and Conditions