Alexander E. Yakovlev

Peripheral Nerve Stimulation in Treatment of Intractable Postherpetic Neuralgia

Objective.  This case report presents an application of peripheral nerve stimulation to a patient with intractable postherpetic neuralgia that conventional treatment failed to ameliorate.

Spinal Cord Stimulation as a Treatment Option for Intractable Neuropathic Cancer Pain

Nearly 6,750,000 people suffer moderate to severe cancer-related pain each year. Unfortunately, 10% to 15% of these patients fail to achieve acceptable pain relief with conventional management. Spinal cord stimulation (SCS) has been used with increased frequency for successful treatment of intractable cancer pain. We present two cases of intractable, refractory-to-conventional treatment cancer pain that were successfully treated with SCS. Case 1 reports a 51-year-old male with burning pain at the left groin site of inguinal metastases, post-surgical and intraoperative radiation therapy for treatment of squamous cell carcinoma of the anus. Case 2 reports a 43-year-old woman with intractable, burning, throbbing, and shooting pain, post-debulking followed by radiation of a metastatic colon carcinoma. In both cases SCS implantation provided 90% to 100% pain relief, improved functioning and sleep, and discontinuation of pain medications, sustained through 12 months.

Peripheral nerve field stimulation in the treatment of postlaminectomy syndrome after multilevel spinal surgeries.

Introduction:  Chronic low back pain in patients with postlaminectomy syndrome (PLS) is challenging to treat, especially for patients who have undergone multilevel surgical procedures. Despite conservative therapy and available interventional pain procedures including spinal cord stimulation (SCS) and intrathecal therapies, patients may continue with intractable low back pain. Peripheral nerve field stimulation (PNFS) may represent an effective alternative treatment option for these patients when conventional treatments do not provide adequate relief of intractable low back pain.

Treatment of Cancer-Related Chest Wall Pain Using Spinal Cord Stimulation

Objective: It has been estimated that 15% to 40% of chronic cancer pain has a neuropathic component, and this type of pain often responds poorly to opioids. In an attempt to provide increased pain relief for patients with intractable cancer pain, unconventional agents and interventional management approaches have received considerable attention. Spinal cord stimulation (SCS) has been used with increased frequency for the treatment of intractable cancer pain. Methods: The patients with a history of cancer-related chest wall pain underwent an uneventful SCS trial with percutaneous placement of 2 temporary 8-electrode leads (Medtronic Inc, Minneapolis, Minnesota) placed at the level of T3-T4-T5. Results: After experiencing excellent pain relief over the next 2 days, the patients were implanted with permanent leads and rechargeable generator 2 to 2 ½ weeks later and reported sustained pain relief at 12-month follow-up visit. Conclusion: SCS provides an effective, alternative treatment option for select patients with cancer-related chest wall pain who have failed conservative treatment. SCS may provide pain relief with advantages over conservative treatments and more invasive techniques.

Successful treatment of chronic neuropathic pain with subcutaneous peripheral nerve stimulation: four case reports.

Introduction. Chronic pain is a prevalent medical condition in the general population and is one of the most common reasons patients visit their primary care doctors. When the pain is resistant to the common treatment modalities, it presents a challenge for the physician and may have profound consequences for the quality of life of the patient. Methods. We present four case reports in which subcutaneous peripheral nerve stimulation was successfully used to treat chronic neuropathic pain after all other treatment efforts had failed. Results. In all cases, the patients underwent a trial of peripheral nerve stimulation with good results. The patients reported decreased use of pain medications, increased quality of life, and high satisfaction with the procedure results. Conclusion. The use of subcutaneous peripheral nerve stimulation as a viable treatment alternative in certain cases of chronic neuropathic pain should continue to be rigorously evaluated.

Spinal cord stimulation for cancer-related low back pain.

Objective: At least one third of patients with cancer have pain at the time of their diagnosis. In an attempt to provide increased pain relief for patients with intractable cancer pain, unconventional agents and interventional procedures including spinal cord stimulation (SCS) have received considerable attention. Methods: Patients with cancer-related low back pain underwent an uneventful SCS trial with percutaneous placement of 2 temporary 8-electrode leads placed at the level of T8-T9-T10. Results: After experiencing excellent pain relief during the 2-day trial, patients were subsequently implanted with permanent leads and generator with sustained pain relief at 12 months postoperation. Conclusion: Spinal cord stimulation provides an effective, alternative treatment option for select patients with cancer-related pain who have failed conservative treatment.

Spinal Cord Stimulation as Alternative Treatment for Chronic Post‐Herniorrhaphy Pain

Objective:  Our goal was to determine the efficacy of spinal cord stimulation for patients with intractable post‐herniorrhaphy pain which conventional treatment failed to ameliorate.

Treatment of chronic intractable atypical facial pain using peripheral subcutaneous field stimulation.

Introduction:  Atypical facial pain (ATFP) is challenging to manage and there are few proven therapies available. We present a case report describing application of peripheral subcutaneous field stimulation (PSFS) to a patient with chronic intractable ATFP which conventional treatment failed to ameliorate.

Treatment of Urinary Voiding Dysfunction Syndromes With Spinal Cord Stimulation

This case report presents the use of spinal cord stimulation (SCS) in a patient with urinary incontinence who had previously undergone trial and implantation of InterStim therapy (Medtronic Neurological, Minneapolis, MN). The patient also experienced bilateral lower extremity pain and low back pain related to post-laminectomy syndrome. Having failed all conservative treatment, the patient underwent SCS trial and subsequent implantation. In the postoperative period using SCS therapy, the patient had excellent relief of urinary incontinence symptoms, along with relief of low back pain and bilateral lower extremity pain and was able to discontinue use of InterStim therapy. For this patient, SCS was effective in controlling the urinary voiding dysfunction symptoms, bilateral lower extremity pain and back pain. The use of SCS to treat urinary incontinence problems deserves further study to explore its therapeutic potentials.

Treatment of Chronic Intractable Hip Pain After Iliac Crest Bone Graft Harvest Using Peripheral Nerve Field Stimulation

Introduction:  Autologous iliac crest bone graft (ICBG) harvest is a common procedure performed at the time of many spinal surgical procedures and associated with morbidity incurred at the harvest site, the most troublesome being chronic donor site pain.