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Peripheral Nerve Stimulation for Chronic Abdominal Pain

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Chronic Abdominal Pain

Abstract

The use of peripheral approaches to chronic abdominal pain follows the rapid increase in its use in other pain states. Although the mechanism of action in peripheral Neuromodulation is not as well established as spinal cord stimulation, it may have differences that will allow it to work either as a standalone therapy or in combination with conventional neuromodulation approaches. Targets that may be accessed via a peripheral approach include abdominal wall, ilioinguinal nerves, splanchnic and lumbar sympathetic nerves. Both peripheral nerve and subcutaneous targeted and field stimulation have been used successfully. The use of non-invasive peripheral neuromodulation is also discussed and this is another rapidly expanding field.

Although the data available on the usefulness of the peripheral approach is still limited, but the results are encouraging and long term outcomes are still required. The mechanism of the action of both SCS and peripheral stimulation in pain relief needs to be investigated further. In the future refinements in the techniques and technology will drive its use and form the basis of further clinical study. Neuromodulation techniques as a modality for the treatment of chronic abdominal pain are relatively new, but this is a very promising option for the treatment of chronic visceral abdominal pain.

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References

  1. Gildenberg PL. History of neuromodulation for chronic pain. Pain Med. 2006;7:S7–13.

    Article  Google Scholar 

  2. Althaus J. Dilatation of the stomach. In: The value of electrical treatment. Paternoster Row: Longmans & Co.; 1895. p. 79–80.

    Google Scholar 

  3. Melzack R, Wall P. Pain mechanisms: a new theory. Science. 1965;150:971–8.

    Article  CAS  PubMed  Google Scholar 

  4. Wall P, Sweet WH. Temporary abolition of pain in man. Science. 1967;155:108–9.

    Article  CAS  PubMed  Google Scholar 

  5. Sweet WH, Wepsic JG. Treatment of chronic pain by stimulation of fibres of primary afferent neurons. Trans Am Neurol Assoc. 1968;93:103–7.

    CAS  PubMed  Google Scholar 

  6. Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46(4):489–91.

    Article  CAS  PubMed  Google Scholar 

  7. Nielson KD, Watts C, Clark WK. Peripheral nerve injury from implantation of chronic stimulating electrodes for pain control. Surg Neurol. 1976;5:51–3.

    CAS  PubMed  Google Scholar 

  8. Weiner RL, Reed KL. Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation. 1999;2:217–21.

    Article  CAS  PubMed  Google Scholar 

  9. Dunteman E. Peripheral nerve stimulation for unremitting ophthalmic post-herpetic neuralgia. Neuromodulation. 2002;5(1):32–7.

    Article  PubMed  Google Scholar 

  10. Yakovlev AE, Resch BE. Treatment of chronic intractable atypical facial pain using peripheral subcutaneous field stimulation. Neuromodulation. 2010;13:137–40.

    Article  PubMed  Google Scholar 

  11. Yakovlev AE, Peterson AT. Peripheral nerve stimulation in treatment of intractable post herpetic neuralgia. Neuromodulation. 2007;10(4):373–5.

    Article  PubMed  Google Scholar 

  12. Stinson LW, Roderer GT, Cross NE, David BE. Peripheral subcutaneous neurostimulation for control of intractable post-operative inguinal pain: a case report series. Neuromodulation. 2001;4(3):99–104.

    Article  PubMed  Google Scholar 

  13. Kothari S, Goroszeniuk T. Percutaneous permanent electrode implantation to ulnar nerves for upper extremity chronic pain: 6 year follow up. Reg Anesth Pain Med. 2006;31(5 Suppl):16.

    Article  Google Scholar 

  14. Siddalingaiah V, Goroszeniuk T, Palmisani S, Bagchi S, Sanderson K, Al-Kaisy A. Permanent percutaneous sciatic nerve stimulation for treatment of severe neuropathic pain. 13th World Congress on pain, Montreal, Canada, 29 August–2 September 2010.

    Google Scholar 

  15. Goroszeniuk T, Kothari S, Hamann W. Percutaneous implantation of a brachial plexus electrode for management of pain syndrome caused by a traction injury. Neuromodulation. 2007;10(2):148–55.

    Article  PubMed  Google Scholar 

  16. Goroszeniuk T, Kothari S, Hamann W. Subcutaneous neuromodulating implant targeted at the site of pain. Reg Anesth Pain Med. 2006;31(2):168–71.

    Article  PubMed  Google Scholar 

  17. Sator-Katzenschlager S, Fiala K, Kress HG, Kofler A, Neuhold J, Kloimstein H, Ilias W, Mozes-Balla EM, Pinter M, Loining N, Fuchs W, Heinze G, Likar R. Subcutaneous target stimulation (STS) in chronic noncancer pain: a nationwide retrospective study. Pain Pract. 2010;10(4):265–377.

    Article  Google Scholar 

  18. Goroszeniuk T, Pang D, Al-Kaisy A, Sanderson K. Subcutaneous target stimulation—peripheral subcutaneous field stimulation in the treatment of refractory angina: preliminary case reports. Pain Pract. 2011;11(2):1–9.

    Google Scholar 

  19. Buiten MS, DeJonste MJL, Beese U, Kliphuis C, Durenkamp A, Staal MJ. Subcutaneous electrical nerve stimulation: a feasible and new method for the treatment of patients with refractory angina. Neuromodulation. 2011;14:258–65.

    Article  PubMed  Google Scholar 

  20. Grundy D. Neuroanatomy of visceral nociception: vagal and splanchnic afferent. Gut. 2002;51 Suppl 1:2–5.

    Article  Google Scholar 

  21. Naidoo N, Partaba P, Singh B, Moodley J, Satyapal KS. Thoracic splanchnic nerves: implications for splanchnic denervation. J Anat. 2001;199:585–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Al-Chaer ED, Willis WD. Neuroanatomy of visceral pain: pathways and processes. In: Pasricha PJ, Willis WD, Gebhart GF, editors. Chronic abdominal and visceral pain theory and practice. New York: Informa Healthcare; 2007. p. 33–43.

    Google Scholar 

  23. Qin C, Chen JD, Zhang J, Foreman RD. Modulatory effects and afferent pathways of gastric electrical stimulation on thoracic spinal neurons receiving input from stomach in rats. Neurosci Res. 2007;57:29–39.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Goroszeniuk T, Khan R, Kothari S. Lumbar sympathetic chain neuromodulation with implanted electrodes for long term pain relief in loin pain haematuria syndrome. Neuromodulation. 2009;12(4):284–91.

    Article  PubMed  Google Scholar 

  25. Goroszeniuk T. Short neuromodulation trial in neuropathic pain produces varying duration but reproducible pain relief. Proceedings of the 4th Congress of EFIC, September 2–6, Prague, Czech Republic; 2003. p. 326.

    Google Scholar 

  26. Al Tamimi M, Davids HR, Barolat G, Krutsch J, Ford T. Subcutaneous peripheral nerve stimulation treatment for chronic pelvic pain. Neuromodulation. 2008;11:277–81.

    Article  PubMed  Google Scholar 

  27. Sluka KA, Deacon M, Stibal A, Strissel S, Terpstra A. Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. J Pharmacol Exp Ther. 1999;289:840–6.

    CAS  PubMed  Google Scholar 

  28. Kalra A, Urban MO, Sluka KA. Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS). J Pharmacol Exp Ther. 2001;298:257–63.

    CAS  PubMed  Google Scholar 

  29. Radhakrishnan R, Sluka KA. Spinal muscarinic receptors are activated during low or high frequency TENS-induced antihyperalgesia in rats. Neuropharmacology. 2003;45:1111–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Radhakrishnan R, King EW, Dickman J, Herold CA, Johnston NF, Spurgin ML, Sluka KA. Blockade of spinal 5-HT receptor subtypes prevents low, but not high, frequency TENS-induced antihyperalgesia in rats. Pain. 2003;105:205–13.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Maeda Y, Lisi TL, Vance CG, Sluka KA. Release of GABA and activation of GABAA receptors in the spinal cord mediates the effects of TENS in rats. Brain Res. 2007;1136:43–50.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Sluka KA, Lisi TL, Westlund KN. Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electric nerve stimulation in rats with joint inflammation. Arch Phys Med Rehabil. 2006;87:1137–40.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Chandran P, Sluka KA. Development of opioid tolerance with repeated transcutaneous electrical nerve stimulation administration. Pain. 2003;102:195–201.

    Article  CAS  PubMed  Google Scholar 

  34. Han JS, Chen XH, Sun SL, Xu XJ, Yuan Y, Yan SC, Hao JX, Terenius L. Effect of low and high frequency TENS on met-enkephalin-arg-phe and dynorphin A immunoreactivity in human lumbar CSF. Pain. 1991;47:295–8.

    Article  CAS  PubMed  Google Scholar 

  35. Salar G, Job I, Mingrino S, Bosio A, Trabucchi M. Effect of transcutaneous electrotherapy on CSF β-endorphin content in patients without pain problems. Pain. 1981;10:169–72.

    Article  CAS  PubMed  Google Scholar 

  36. Matharu M, Bartsch T, Ward N, Frackowiak R, Weiner R, Goadsby P. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain. 2004;127:220–30.

    Article  PubMed  Google Scholar 

  37. Ignelzi RJ, Nyquist JK. Direct effect of electrical stimulation on peripheral nerve evoked activity: implications in pain relief. J Neurosurg. 1976;45:159–65.

    Article  CAS  PubMed  Google Scholar 

  38. Sandkühler J, Chen JG, Cheng G, Randić M. Low-frequency stimulation of afferent Adelta-fibers induces long-term depression at primary afferent synapses with substantia gelatinosa neurons in the rat. J Neurosci. 1997;17(16):6483–91.

    PubMed  Google Scholar 

  39. Randić M, Jiang MC, Cerne R. Long-term potentiation and long-term depression of primary afferent neurotransmission in the rat spinal cord. J Neurosci. 1993;13(12):5228–41.

    PubMed  Google Scholar 

  40. Ellrich J, Lamp S. Peripheral nerve stimulation inhibits nociceptive processing: an electrophysiological study in healthy volunteers. Neuromodulation. 2005;8(4):225–32.

    Article  PubMed  Google Scholar 

  41. Linderoth B, Meyerson B. Spinal cord stimulation: exploration of the physiological basis of a widely used therapy. Anesthesiology. 2010;113(6):1265–7.

    Article  PubMed  Google Scholar 

  42. Linderoth B. Spinal cord stimulation: a brief update on mechanism of action. Eur J Pain Suppl. 2009;3(2):89–93.

    Article  Google Scholar 

  43. Qin C, Chen JDZ, Zhang J, Foreman RD. Somatic afferent modulation of thoracic (T9-T10) spinal neurons receiving gastric mechanical input in rats. Neuromodulation. 2010;13:77–86.

    Article  PubMed  Google Scholar 

  44. Butterworth JF. Case reports: unstylish but still useful sources of clinical information. Reg Anesth Pain Med. 2009;34(3):187–8.

    Article  PubMed  Google Scholar 

  45. Paicius RM, Bernstein CA, Lempert-Cohen C. Peripheral nerve field stimulation in chronic abdominal pain. Pain Physician. 2006;9:261–6.

    PubMed  Google Scholar 

  46. Abejón D, Deer T, Verrills P. Subcutaneous stimulation: how to assess optimal implantation depth. Neuromodulation. 2011;14:343–8.

    Article  PubMed  Google Scholar 

  47. Pang D, Goroszeniuk T, O’Keeffe D, Shetty A, Racz G. Novel stimulating needle for peripheral and subcutaneous neuromodulation. 6th World Congress-World Institute of Pain. Pain Practice, 2012;12:1–199. doi:10.1111/j.1533-2500.2011.00528.x.

  48. Goroszeniuk T, Pang D, Kothari S. Targeting and fielding: not the same! Neuromodulation. 2011;14:569–70.

    Article  PubMed  Google Scholar 

  49. Abejón D, Krames ES. Peripheral nerve stimulation or is it peripheral subcutaneous field stimulation; what is in a moniker? Neuromodulation. 2009;12:1–4. doi:10.1111/j.1525-1403.2009.00192.x.

    Article  PubMed  Google Scholar 

  50. Goroszeniuk T, Kothari S. Targeted external area stimulation. Reg Anesth Pain Med. 2004;29(5):98.

    Article  Google Scholar 

  51. Kothari S, Goroszeniuk T. External neuromodulation as a diagnostic and therapeutic procedure. Eur J Pain. 2006;10 Suppl 1:S158.

    Google Scholar 

  52. Goroszeniuk T, Pratap N, Kothari S, Sanderson K. An algorithm for peripheral neuromodulation in neuropathic pain. Proceedings of 8th World Congress of INS and 11th Annual Meeting of NANS, December 9–12, 2007b, Acapulco, Mexico. p. 25–26, p. 169–170.

    Google Scholar 

  53. Goroszeniuk T, Pratap N, Sanderson K, Kothari S. Therapeutic trial of peripheral neuromodulation using inexpensive monoelectrode temporary stimulating catheters. Proceedings of 8th World Congress of INS and 11th Annual Meeting of NANS, December 9–12, 2007c, Acapulco, Mexico. p. 150.

    Google Scholar 

  54. Goroszeniuk T, Khan R. Permanent percutaneous splanchnic nerve neuromodulation for management of pain due to chronic pancreatitis: a case report. Neuromodulation. 2011;14(3):253–7.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Pain Management and Neuromodulation Centre, St Thomas’ Hospital, Guy’s & St. Thomas’ NHS Foundation Trust Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    David Pang MBChB, FRCA, FFPMRCA

  2. Interventional Pain Management and Neuromodulation Practice, London, W1G 8GD, UK

    Teodor Goroszeniuk F.F.A.R.C.S.I., F.F.P.M.C.A.I.

Authors
  1. David Pang MBChB, FRCA, FFPMRCA
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  2. Teodor Goroszeniuk F.F.A.R.C.S.I., F.F.P.M.C.A.I.
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Correspondence to David Pang MBChB, FRCA, FFPMRCA .

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Editors and Affiliations

  1. Medical Director, Carolinas Pain Institute and Clinical Research Center, Professor of Anesthesiology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina, USA

    Leonardo Kapural

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Pang, D., Goroszeniuk, T. (2015). Peripheral Nerve Stimulation for Chronic Abdominal Pain. In: Kapural, L. (eds) Chronic Abdominal Pain. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1992-5_20

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  • DOI: https://doi.org/10.1007/978-1-4939-1992-5_20

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