Peripheral Cortical and Deep Brain Stimulation

Although this chapter concentrates on the technique of SCS, it must be noted that neurostimulation can be used successfully at other locations in the peripheral and central nervous systems to provide analgesia.

Peripheral nerve stimulation was introduced by Wall, Sweet, and others38 in the mid-1960s. This technique has shown efficacy for peripheral nerve injury pain syndromes as well as CRPS, with the use of a carefully implanted paddle lead utilizing a fascial graft to help anchor the lead without traumatizing the nerve.39

Motor cortex and deep brain stimulation are techniques that have been explored to treat highly refractory neuropathic pain syndromes, including central pain, deafferentation syndromes, trigeminal neuralgia, and others (Figure 7.8).40 Deep brain stimulation has become a widely used technique for movement disorders, and much less so for painful indications, although there have been many case reports of utility in treating highly refractory central pain syndromes.41

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