A novel method of neurostimulation of the peripheral nervous system: The StimRouter implantable device

Abstract The nervous system is a dynamic and plastic structure that modulates the transduction and transmission of neuropathic and nociceptive pain. Traditionally, the focus of neuromodulation treatment has been on the central nervous system: spinal cord stimulation, motor cortex stimulation, and deep brain stimulation. Observational experience suggests that peripheral neuromodulatory techniques show promise as peripheral targets, both as stand-alone therapies and as an adjuvant in hybrid systems lead arrays. Currently, there are only a few neuromodulatory devices designed specifically for the periphery. We review one of these novel modalities: the StimRouter. We describe a novel strategy of stimulating named peripheral nerves with the StimRouter. Initial clinical data have shown successful implantation of this novel device and improvement in the acute setting. Currently, a multicenter study is under way to access the success of this novel method of stimulation in the long-term setting. The potential success of the StimRouter could affect peripheral neuromodulatory strategies.

[1]  A. Burgher,et al.  Feasibility of Ultrasound‐Guided Percutaneous Placement of Peripheral Nerve Stimulation Electrodes and Anchoring During Simulated Movement: Part Two, Upper Extremity , 2008, Regional anesthesia and pain medicine.

[2]  S. Wolf,et al.  Applications of transcutaneous electrical nerve stimulation in the management of patients with pain. State-of-the-art update. , 1985, Physical therapy.

[3]  A. Burgher,et al.  Ultrasound-guided permanent implantation of peripheral nerve stimulation (PNS) system for neuropathic pain of the extremities: original cases and outcomes. , 2009, Pain medicine.

[4]  J. Henderson,et al.  Intracranial neurostimulation for pain control: a review. , 2010, Pain physician.

[5]  Peter Kosek,et al.  Sensor-driven position-adaptive spinal cord stimulation for chronic pain. , 2012, Pain physician.

[6]  H. Yamanaka,et al.  [Pathophysiology of neuropathic pain: molecular mechanisms underlying central sensitization in the dorsal horn in neuropathic pain]. , 2012, Brain and nerve = Shinkei kenkyu no shinpo.

[7]  T. Lamer,et al.  Feasibility of Ultrasound‐Guided Percutaneous Placement of Peripheral Nerve Stimulation Electrodes in a Cadaver Model: Part One, Lower Extremity , 2008, Regional anesthesia and pain medicine.

[8]  T. Deer,et al.  Occipital neurostimulation-induced muscle spasms: implications for lead placement. , 2009, Pain physician.

[9]  R. Bittar,et al.  Peripheral neuromodulation for pain , 2009, Journal of Clinical Neuroscience.

[10]  T. Deer,et al.  Prospective Clinical Study of a New Implantable Peripheral Nerve Stimulation Device to Treat Chronic Pain , 2010, The Clinical journal of pain.

[11]  R. Tubbs,et al.  Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia. , 2006, Folia morphologica.

[12]  P. Wall,et al.  Pain mechanisms: a new theory. , 1965, Science.

[13]  R. Melzack,et al.  Transcutaneous electrical nerve stimulation for low back pain. A comparison of TENS and massage for pain and range of motion. , 1983, Physical therapy.

[14]  M. Schiefer,et al.  Fascicular Perineurium Thickness, Size, and Position Affect Model Predictions of Neural Excitation , 2008, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[15]  S. Hassenbusch,et al.  Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy. , 1996, Journal of neurosurgery.

[16]  J Salamon,et al.  Stimulation of the central and peripheral nervous system for the control of pain. , 1997, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.