Introduction Primary headache disorders are classified mainly as migraine, tension-type headaches, and the trigeminal autonomic cephalgias, which include cluster headaches. “Primary” refers to a lack of clear underlying causative pathology, trauma, or systemic disease. Secondary headaches are usually associated with…
Introduction Peripheral nerve stimulation (PNS) involves placing a small electrical device proximal to peripheral nerves. Prior to proceeding with a PNS trial, it is imperative that the patient receive proper education regarding the device, expectations, and complications, in addition to…
Preoperative Considerations Preoperative work-up for peripheral nerve stimulation (PNS) is similar to that for other advanced implantable procedures such as spinal cord stimulation (SCS). This includes an informed consent discussion with the patient about the different treatment options (including device…
Peripheral Nerve Stimulator Configurations Peripheral nerves can be nonspecifically and specifically targeted for neuromodulation via a variety of configurations. These range from transcutaneous stimulation to partially implanted systems, to fully implanted electrode/receivers with external generators, to fully implanted electrodes and…
Introduction Peripheral nerve stimulation has been around since the early 1960s. These early stimulators were placed under direct visualization during an open surgical procedure. While the results were promising, the obvious disadvantages of having to place stimulators with open surgery…
Introduction The underlying mechanism of peripheral nerve stimulation (PNS) has always been thought to be an extension of the “Gate Theory of Pain,” traditional spinal cord stimulation (SCS) applied to peripheral nerves. While this theory may still hold true, recent…
Introduction There are many poorly recognized or misrecognized peripheral nerve entrapments associated with clinical pain syndromes. Kopell and Thompson stated that peripheral nerve entrapments occur at anatomic sites where the nerve changes direction to enter a fibrous or fibroosseous tunnel,…
Introduction For more than 5000 years, electrical stimulation has been used to treat pain, among other medical conditions. The King Narmer papyrus from 3100 BC describes the use of the Nile catfish, which has a bioelectric generator, for pain control,…
Key Points Understanding the chief executive officer (CEO) mindset and what they worry about helps teams frame performance improvement initiatives in ways that will resonate. Proposed quality improvement projects should ideally have direct ties to an organization's strategic plan or…
Key Points Sustainable quality improvement (QI) aims to deliver care that maximizes positive health outcomes through best use of environmental, social, and financial resources. Average global temperatures on earth are rising because of human activity. The US healthcare industry produces…