Category Archives: Pain

Book: Innovative Neuromodulation

Innovative Neuromodulation
From Academic Press

Innovative Neuromodulation

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Innovative Neuromodulation serves as an extensive reference that includes a basic introduction to the relevant aspects of clinical neuromodulation that is followed by an in-depth discussion of the innovative surgical and therapeutic applications that currently exist or are in development.

This information is critical for neurosurgeons, neurophysiologists, bioengineers, and other proceduralists, providing a clear presentation of the frontiers of this exciting and medically important area of physiology. As neuromodulation remains an exciting and rapidly advancing field―appealing to many disciplines―the editors’ initial work (Essential Neuromodulation, 2011) is well complemented by this companion volume.

  • Presents a comprehensive reference on the emerging field of neuromodulation that features chapters from leading physicians and researchers in the field
  • Provides commentary for perspectives on different technologies and interventions to heal and improve neurological deficits
  • Contains 300 full-color pages that begin with an overview of the clinical phases involved in neuromodulation, the challenges facing therapies and intraoperative procedures, and innovative solutions for better patient care

Product Details

  • Published on: 2017-02-14
  • Original language: English
  • Dimensions: 9.25″ h x 6.25″ w x 1.00″ l,
  • Binding: Hardcover
  • 340 pages

Editorial Reviews

From the Back Cover

Edited by two prominent clinical experts in the field, Innovative Neuromodulation 1e will serve as an extensive reference that includes a basic introduction to the relevant aspects of clinical neuromodulation followed by in-depth discussion of the innovative surgical and therapeutic applications that currently exist or are being developed at present. This information contained is critical for neurosurgeons, neurophysiologists, bioengineers, and other proceduralists, providing a clear presentation of the frontiers of this exciting and medically important area of physiology.

As neuromodulation remains an exciting and rapidly advancing field, appealing to many disciplines, the editors’ initial volume (Essential Neuromodulation, 2011) will be well complemented by this companion volume. Innovative Neuromodulation stands on its own, capturing the up-to-date advances and inspiration that currently grip the field.

About the Author
Jeff Arle, MD, PhD, FAANS
Dr. Arle is currently the Associate Chief of Neurosurgery at Beth Israel Deaconess Medical Center in Boston, the Chief of Neurosurgery at Mt. Auburn Hospital in Cambridge, and an Associate Professor of Neurosurgery at Harvard Medical School. He received his BA in Biopsychology from Columbia University in 1986 and his MD and PhD from the University of Connecticut in 1992. His dissertation work for his doctorate in Biomedical Sciences was in computational modeling in the Cochlear Nucleus. He then went on to do a residency in neurosurgery at the University of Pennsylvania, incorporating a double fellowship in movement disorder surgery and epilepsy surgery under Drs. Patrick Kelly, Ron Alterman, and Werner Doyle, finishing in 1999.

He edited the companion text Essential Neuromodulation with Dr. Shils, the first edition published by Elsevier in 2011. He has now practiced in the field of functional neurosurgery for 17 years and is experienced in all areas of neuromodulation from deep brain stimulators to vagus nerve, spinal cord, peripheral nerve, and motor cortex stimulators, contributing frequent peer-reviewed publications and numerous chapters to the literature on many aspects of the neuromodulation field. He currently serves as an associate editor at the journals Neuromodulation and Neurosurgery, is the co-chair of the Research and Scientific Policy Committee for the International Neuromodulation Society, and is on the Board of Directors for the International Society for Intraoperative Neurophysiology. His longstanding research interests are in the area of computational modeling in the understanding and improved design of devices used in neuromodulation treatments.

Jay L. Shils, Ph.D., D.ABNM, FASNM, FACNS is the director of intra-operative neurophysiology and associate professor in anesthesiology at Rush University Medical center in Chicago, IL. He received his Bachelor of Science degree in electrical engineering from Syracuse University, and both his masters and PhD in Bio-Engineering at The University of Pennsylvania investigating higher order signal extraction and processing techniques on human EEG data to investigate interactions in the visual system and in epilepsy.

He began his work in the field of intraoperative neurophysiology in 1995 specializing in single unit recordings during surgery for movement disorders in the department of Neurology at the University of Pennsylvania School of medicine. Dr. Shils’ research interests include investigating methods for improving real-time intraoperative neurophysiologic techniques as well as theoretical research in neuromodulation mechanisms of action. Dr. Shils has published over 30 peer reviewed papers and multiple chapters on intraoperative neurophysiologic surgical technique, post-operative management of movement disorders patients, and computational modeling as related to neuromodulation effects on various neural circuits. He is the co-editor of two books: “Neurophysiology in Neurosurgery: A modern approach” with Dr. Vedran Deletis; and “Essential Neuromodulation” with Dr. Jeffrey E. Arle. Prior to going to graduate school Dr. Shils was an electrical engineer at the Electric Boat division of General Dynamics where he was involved in various modifications to existing electrical systems.

Dr. Shils is the past President of the International Society for Intraoperative Monitoring and was the founding secretary of the society. He is a past board member of and past chairman for the American Society of Neurophysiologic Monitoring ethics committee and is the 2106/2017 president of the ASNM. He is an associate editor for the Journal of Neurosurgery and Journal of Clinical Neurophysiology.

Animal models for central poststroke pain: a critical comprehensive review

Dejerine Roussy syndrome or thalamic pain syndrome is a condition developed after a thalamic stroke, a stroke causing damage to the thalamus.

Ischemic strokes and hemorrhagic strokes can cause lesioning in the thalamus. The lesions, usually present in one hemisphere of the brain, most often cause an initial lack of sensation and tingling in the opposite side of the body. Weeks to months later, numbness can develop into severe and chronic pain that is not proportional to an environmental stimulus, called dysaesthesia or allodynia.

As initial stroke symptoms, numbness and tingling, dissipate, an imbalance in sensation causes these later syndromes, characterizing Dejerine–Roussy syndrome. Although some treatments exist, they are often expensive, chemically based, invasive, and only treat patients for some time before they need more treatment, called “refractory treatment.”

Thalamic pain syndrome is a condition developed after a thalamic stroke.

Research into its underlying mechanisms and treatment options could benefit from a valid animal model. Nine different animal models have been published, but there are relatively few reports on successful reproductions of these models and so far only little advances in the understanding or the management have been made relying on these models. In general, the construct validity (similarity in underlying mechanisms) of these animal models is relatively high, although this cannot be evaluated into depth because of lack of understanding the mechanisms through which thalamic stroke can lead to thalamic pain syndrome. The face validity (symptom similarity) is relatively low, mainly because pain in these models is tested almost exclusively through evoked mechanical/thermal hypersensitivity assessed by reflexive measures and given the conflicting results with similar tests in patients with thalamic pain syndrome. The predictive validity (similarity in treatment efficacy) has not been evaluated in most models and incorporates difficulties that are specific to thalamic pain syndrome.

De Vloo et al., compare the different models regarding these types of validity and discuss the robustness, reproducibility, and problems regarding the design and reporting of the articles establishing these models. They conclude with various proposals on how to improve the validity and reproducibility of thalamic pain syndrome animal models. Until further improvements are achieved, prudence is called for in interpreting results obtained through these models 1).


1) De Vloo P, Morlion B, van Loon J, Nuttin B. Animal models for central poststroke pain: a critical comprehensive review. Pain. 2017 Jan;158(1):17-29. PubMed PMID: 27992392.

Update: Geniculate neuralgia

J.Sales-Llopis

Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain

Geniculate neuralgia is a pain syndrome associated with the nervus intermedius.

Epidemiology

Fewer than 150 reported cases were published in English between 1932 and 2012 1).

Etiology

The etiology of the condition remains unknown 2).

Symptoms

The pain may also be of gradual onset and of a dull, persistent nature, with occasional sharp, stabbing pain like an electric shock, deep in the ear 3).

Some people have reported additional symptoms during pain attacks:

Salivation

Bitter taste

Tinnitus

Vertigo

Diagnosis

The clinical presentation varies. Non-neuralgic causes of otalgia should always be excluded by a thorough clinical examination, audiological assessment and radiological investigations before making a diagnosis of geniculate neuralgia 4).

Differential diagnosis

Due to the close anatomical proximity, temporomandibular joint (TMJ) pathologies should be included in the differential diagnosis.

Easily confused with trigeminal neuralgia and glossopharyngeal neuralgia. However, nerves intermedius has its characteristic clinical syndroms to be diagnosed.

see Ramsay Hunt syndrome.

Treatment

The treatment has not been established, although it seems reasonable that the therapeutic approaches used in other more common craniofacial neuralgias, such as trigeminal neuralgia, should be effective.

Conservative medical treatment is always the first-line therapy.

Surgical treatment should be offered if medical treatment fails. The two commonest surgical options are transection of the nervus intermedius, and microvascular decompression of the nerve at the nerve root entry zone of the brainstem. However, extracranial intratemporal division of the cutaneous branches of the facial nerve may offer a safer and similarly effective treatment.

The response to medical treatment for this condition varies between individuals. The long-term outcomes of surgery remain unknown because of limited data 5).

Geniculate ganglion section

Rupa et al., postulate that geniculate ganglionectomy may be ineffective as the sole treatment for certain cases of geniculate neuralgia, and that nervus intermedius section may also be required to achieve a more complete deafferentation 6).

Case series

2015

Thirumala et al., analyzed preoperative and postoperative audiogram data and brainstem auditory evoked potentials (BAEPs) from 8 patients with GN who underwent MVD. Differences in pure tone audiometry > 10 dB at frequencies of 0.25, 0.5, 1, 2, 4, and 8 kHz were calculated preoperatively and postoperatively for both the ipsilateral and the contralateral sides. Intraoperative monitoring records were analyzed and compared with the incidence of HFHL, which was defined as a change in pure tone audiometry > 10 dB at frequencies of 4 and 8 kHz.

High-frequency hearing loss occurred after MVD for TGN, GPN, or GN, and the greatest incidence occurred on the ipsilateral side. This hearing loss may be a result of drill-induced noise and/or transient loss of cerebrospinal fluid during the course of the procedure. Changes in intraoperative BAEP waveforms were not useful in predicting HFHL after MVD. Repeated postoperative audiological examinations may be useful in assessing the prognosis of HFHL 7).

2002

Excision of the nervus intermedius and/or of the geniculate ganglion by the middle cranial fossa approach without the production of facial paralysis, in any of 15 cases with geniculate neuralgia is reported. Use of these technique, sometimes in combination with selective section of the Vth cranial nerve, has been successful in relieving the pain of geniculate neuralgia 8).

In 2002 Pulec, review the long-term outcomes in 64 patients who were treated in this manner. Findings indicate that excision of the nervus intermedius and geniculate ganglion can be routinely performed without causing facial paralysis and that it is an effective definitive treatment for intractable geniculate neuralgia 9).

1997

After failing conservative treatment and after undergoing neurologic, otologic, and dental evaluations, 14 patients underwent 20 intracranial procedures consisting of retromastoid craniectomies with microvascular decompression of cranial nerves V, IX, and X with section of the nervus intermedius in most cases.

At operation, vascular compression of the nerves and nervus intermedius was found, which implicated vascular compression as an etiology of this disorder. Initially, 10 of 14 patients had an excellent outcome (71.5%), 3 experienced partial relief (21.5%), and there was 1 failure (7%). Ten patients were available for long-term (> 12 months) follow-up. Of these 10, 3 retained the excellent result (30%), 6 experienced partial relief (60%), and there was 1 failure (10%). Complications included one transient facial paresis, one facial numbness, one paresis of cranial nerves IX and X, one chemical meningitis, two cerebrospinal fluid leaks, and one superficial wound infection. Of those that fell from the excellent to partial category, this usually involved a return of atypical facial pain, but otalgia remained resolved.

Overall, good results (with excellent or partial relief) were found long term for 90% of patients in this series. The authors recommend microvascular decompression of cranial nerves V, IX, and X with nervus intermedius section for the treatment of geniculate neuralgia 10).

Case reports

2014

A case illustration was presented that demonstrates the novel brainstem functional imaging findings for geniculate neuralgia. A 39-year-old man presented with a history of left “deep” ear pain within his ear canal. He noted occasional pain on the left side of his face around the ear. He had been treated with neuropathic pain medications without relief. His wife described suicidal ideations discussed by her husband because of the intense pain.

The patient’s neurologic examination was normal, and otolaryngologic consultation revealed no underlying structural disorder. Anatomic imaging revealed a tortuous vertebral artery-posterior inferior cerebellar artery complex with the posterior inferior cerebellar artery loop impinging on the root entry zone of the nervus intermedius-vestibulocochlear nerve complex and just inferior to the root entry zone of the facial nerve and a small anterior inferior cerebellar artery loop interposed between the cranial nerve VII-VIII complex and the hypoglossal and glossopharyngeal nerves. A left-sided retromastoid craniotomy was performed, and the nervus intermedius was transected. An arterial loop in contact with the lower cranial nerves at the level of the brainstem was mobilized with a polytetrafluoroethylene implant.

The patient indicated complete relief of his preoperative pain after surgery. He has remained pain-free with intact hearing and balance 11).

2007

Figueiredo et al., present a case report of a female patient who was successfully managed with pharmacological treatment 12).

1984

A patient had combined otalgia and intractable unilateral facial spasm, relieved by microsurgical vascular decompression of the seventh and eighth cranial nerve complex in the cerebellopontine angle without section of the intermediate nerve. A dolicho-ectatic anterior inferior cerebellar artery compressed the seventh and eighth cranial nerves complex, suggesting that vascular compression of the intermediate nerve or of the sensory portion of the facial nerve may cause geniculate neuralgia. “Tic convulsif” seems to be a combination of geniculate neuralgia and hemifacial spasm. This combination could be due to vascular compression of the sensory and motor components of the facial nerve at their junction with the brainstem 13).


1) , 2) , 4) , 5) Tang IP, Freeman SR, Kontorinis G, Tang MY, Rutherford SA, King AT, Lloyd SK. Geniculate neuralgia: a systematic review. J Laryngol Otol. 2014 May;128(5):394-9. doi: 10.1017/S0022215114000802. Review. PubMed PMID: 24819337.
3) , 8) Pulec JL. Geniculate neuralgia: diagnosis and surgical management. Laryngoscope. 1976 Jul;86(7):955-64. PubMed PMID: 933690.
6) Rupa V, Weider DJ, Glasner S, Saunders RL. Geniculate ganglion: anatomic study with surgical implications. Am J Otol. 1992 Sep;13(5):470-3. PubMed PMID: 1443083.
7) Thirumala P, Meigh K, Dasyam N, Shankar P, Sarma KR, Sarma DR, Habeych M, Crammond D, Balzer J. The incidence of high-frequency hearing loss after microvascular decompression for trigeminal neuralgia, glossopharyngeal neuralgia, or geniculate neuralgia. J Neurosurg. 2015 Dec;123(6):1500-6. doi: 10.3171/2014.10.JNS141101. PubMed PMID: 25932612.
9) Pulec JL. Geniculate neuralgia: long-term results of surgical treatment. Ear Nose Throat J. 2002 Jan;81(1):30-3. Review. PubMed PMID: 11816385.
10) Lovely TJ, Jannetta PJ. Surgical management of geniculate neuralgia. Am J Otol. 1997 Jul;18(4):512-7. PubMed PMID: 9233495.
11) Tubbs RS, Mosier KM, Cohen-Gadol AA. Geniculate neuralgia: clinical, radiologic, and intraoperative correlates. World Neurosurg. 2013 Dec;80(6):e353-7. doi: 10.1016/j.wneu.2012.11.053. PubMed PMID: 23178920.
12) Figueiredo R, Vazquez-Delgado E, Okeson JP, Gay-Escoda C. Nervus intermedius neuralgia: a case report. Cranio. 2007 Jul;25(3):213-7. Review. PubMed PMID: 17696039.
13) Yeh HS, Tew JM Jr. Tic convulsif, the combination of geniculate neuralgia and hemifacial spasm relieved by vascular decompression. Neurology. 1984 May;34(5):682-3. PubMed PMID: 6538661.

Regional Nerve Blocks in Anesthesia and Pain Therapy: Traditional and Ultrasound-Guided Techniques

Regional Nerve Blocks in Anesthesia and Pain Therapy: Traditional and Ultrasound-Guided Techniques

By Danilo Jankovic, Philip Peng

Regional Nerve Blocks in Anesthesia and Pain Therapy: Traditional and Ultrasound-Guided Techniques

Price: $349.00

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In recent years the field of regional anesthesia, in particular peripheral and neuraxial nerve blocks, has seen an unprecedented renaissance following the introduction of ultrasound-guided regional anesthesia. This comprehensive, richly illustrated book discusses traditional techniques as well as ultrasound-guided methods for nerve blocks and includes detailed yet easy-to-follow descriptions of regional anesthesia procedures. The description of each block is broken down into the following sections: definition; anatomy; indications; contraindications; technique; drug choice and dosage; side effects; potential complications and how to avoid them; and medico-legal documentation. A checklist record for each technique and a wealth of detailed anatomical drawings and illustrations offer additional value. Regional Nerve Blocks in Anesthesia and Pain Medicine provides essential guidelines for the application of regional anesthesia in clinical practice and is intended for anesthesiologists and all specialties engaged in the field of pain therapy such as pain specialists, surgeons, orthopedists, neurosurgeons, neurologists, general practitioners, and nurse anesthetists.


Product Details

  • Published on: 2016-12-16
  • Original language: English
  • Number of items: 1
  • Dimensions: 11.00″ h x .0″ w x 8.30″ l,
  • Binding: Paperback
  • 1010 pages

Book: Techniques of Neurolysis

Techniques of Neurolysis
Techniques of Neurolysis

Price:$109.00
Written and edited by the foremost practitioners of neurolysis, this completely revised and updated second edition assembles the current methods of neurolytic procedures into a single volume.  The book explains in great detail trigeminal and radiofrequency techniques, facet joint denervation, cryoneurolysis and lumbosacral, thoracic and cervial neuroplasty. The new concept of the scarring triangle and treatment that may prevent surgical failures is proposed. Neuroaugmentation and complimentary procedures are also covered.  Indications, contraindications, and complications of these treatments are discussed along with outcomes on some of the case studies featured in the first edition.  Interventional pain physicians, as well as palliative pain physicians, neurosurgeons, and orthopedic spine surgeons, will find this text to be the definitive reference on neurolysis in clinical practice.

About the Author

Gabor B. Racz, MD, ChB, DABPM, FIPP
Grover E. Murray Professor, and Chairman Emeritus,
Department of Anesthesiology;
Co-Director of Pain Services,
Texas Tech University Health Sciences Center,
Lubbock, Texas, USA

Carl Edward Noe, M.D.
Professor and Fellowship Director,
Department of Anesthesiology and Pain Management,
UT Southwestern Medical Center
Dallas, Texas, USA

Dr. Racz is a professor and chairman emeritus in the department of anesthesiology, and co-director of pain services, at the Texas Tech University Health Sciences Center (TTUHSC). He is also one of the founders of the World Institute of Pain and was president of the institute from 2005-2008. In 1989, he developed the procedure of epidural lysis of adhesions (also known as the Racz Procedure) and developed the Racz catheter.

Dr. Noe is a professor and the director of the fellowship in Anesthesiology and Pain Management at the UT Southwestern Medical Center. He is also on the faculty for the Fellow of Interventional Pain Practice certification offered by the World Institute of Pain.

Book: Pain Management and Palliative Care: A Comprehensive Guide

Pain Management and Palliative Care: A Comprehensive GuidePain Management and Palliative Care: A Comprehensive Guide

Price:$149.00

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This comprehensive book covers the knowledge needed to diagnosis and treat patients with acute and chronic pain. Sections dedicated to patient evaluation, medication management, treating patients with more complex circumstances and interventional management provide clinically-relevant information on an array of topics relevant to both the generalist and specialist. Some sections being organized in a diagnosis based approach help to focus on these topics and serve as a quick reference. A practical and easy-to-use guide, Pain Management and Palliative Care provides a broad foundation on pain assessment and management and is an invaluable daily companion for those managing patients experiencing pain.


Product Details

  • Published on: 2015-11-30
  • Original language: English
  • Number of items: 1
  • Dimensions: .0″ h x .0″ w x .0″ l, .0 pounds
  • Binding: Paperback
  • 391 pages

About the Author

Dr. Kimberly A. Sackheim

New York University Langone Medical Center

Interventional Pain Management

Department of Rehabilitation Medicine

New York, NY

USA.