Mid Atlantic Spine and Pain Physicians, Newark, DE 19713 , USA.
Pain Physician. 2009 Nov-Dec;12(6):965-83.
Relief of regional, non-appendicular pain, particularly low back pain, through spinal cord stimulation (SCS) has proven challenging. Recently, peripheral nerve stimulation (PNS), also known as peripheral nerve field stimulation (PNFS) depending on the stimulation area, has demonstrated efficacy for the treatment of well-localized, small areas of pain involving the abdomen, inguinal region, pelvis, face, occipital area, and low back. More widespread application of peripheral nerve stimulation has been limited by its narrow field of coverage in a larger group of patients with diffuse or poorly localized pain.
To determine if cross talk (the creation of an electrical circuit and therefore electrical stimulation between separate subcutaneously placed PNS leads [i.e. inter-lead stimulation]) was clinically possible across large painful areas, assess the breadth of stimulation coverage via cross talk, evaluate the clinical efficacy of peripheral nerve stimulation cross talk (PNSCT), and confirm the existence of cross talk across a large area in a cadaveric model.
Case series observational report and cadaveric experimentation.
A private, comprehensive interventional pain management practice with pain medicine fellowship training in the United States.
Eighteen consecutive patients with non-appendicular, regional pain were included in the study. Data collection for the implanted patients included the presence or absence of stimulation between the PNS leads, stimulation tolerability, stimulation region, lead orientation, lead montage, inter-lead distance, and pain relief from PNSCT compared to PNS without cross talk. A cadaveric analysis was performed to determine the presence or absence of an electrical circuit with 2 subcutaneously PNS leads to confirm or refute the existence of electrical stimulation from on lead to the other within subcutaneous fat with the leads placed at a significant distance apart from one another.
All 18 patients experienced significant pain relief, reduction of pain medication, and functional improvement. Cadaveric experimentation confirmed the presence of an electrical circuit with PNS leads placed at a distance far apart from one another and verified that inter-lead stimulation (cross talk) does occur in subcutaneous fat over a great distance.
This study was limited by its small sample size, and the short-term follow-up after implantation.
The use of the PNSCT technique allows for significant analgesia for large painful areas that have been poorly captured using traditional SCS techniques and not considered as an option with the current application of peripheral nerve stimulation.
通过脊髓刺激（SCS）缓解区域性、非阑尾疼痛，特别是下腰痛，具有挑战性。最近，外周神经刺激（PNS），也称为外周神经场刺激（PNFS），取决于刺激区域，已被证明对治疗腹部、腹股沟区、骨盆、面部、枕区和下腰痛等小面积、定位明确的疼痛有效。由于其在更大的弥漫性或定位不佳的疼痛患者群体中的覆盖范围较窄，外周神经刺激的更广泛应用受到限制。
确定跨 talk（创建电路并因此在皮下放置的单独 PNS 引线之间进行电刺激[即引线间刺激]）在大面积疼痛区域是否临床可行，通过跨 talk 评估刺激覆盖范围的广度，评估外周神经刺激跨 talk（PNSCT）的临床疗效，并在尸体模型中确认大面积跨 talk 的存在。
病例系列观察性报告和尸体实验。
在美国，一家私人、综合性介入性疼痛管理实践，具有疼痛医学奖学金培训。
研究纳入了 18 例非阑尾、区域性疼痛的连续患者。植入患者的数据收集包括 PNS 引线之间是否存在刺激、刺激耐受性、刺激区域、引线方向、引线排列、引线间距离以及与无跨 talk 的 PNS 相比，PNSCT 减轻疼痛的情况。进行尸体分析以确定 2 个皮下 PNS 引线之间是否存在电路，以确认或反驳皮下脂肪中从一个引线到另一个引线的电刺激的存在，引线彼此之间放置的距离很大。
所有 18 例患者均经历了显著的疼痛缓解、疼痛药物减少和功能改善。尸体实验证实，即使皮下引线彼此之间放置的距离很远，也存在 PNS 引线之间的电路，并且验证了在很大的距离内，引线间刺激（跨 talk）确实发生在皮下脂肪中。
本研究受到样本量小和植入后短期随访的限制。
使用 PNSCT 技术可实现对大面积疼痛区域的显著镇痛，而传统 SCS 技术无法很好地捕捉这些区域，并且当前外周神经刺激的应用也不考虑这些区域。
