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Craniofacial Stimulation and Headache

Clinical Presentation Craniofacial neuralgias are a common source of chronic pain. They can be primary or secondary to insults such as trauma, surgery, tumors, or infections. Occipital neuralgia was one of the first cranial neuralgias to be routinely treated with peripheral nerve blocks. Reports as early as 1969 showed that patients responded well to occipital nerve blocks. Today, occipital nerve blocks are often used in the…

Superior Gluteal Nerve

Introduction Hip joint pain and pathology is traditionally separated into anterior and posterior innervations. Anterior innervation is provided by the articular branches of the femoral (anterior capsule) and obturator (anteromedial capsule) nerves. The posterior innervation is by articular branches of the sciatic nerve (posteromedial), nerve to quadratus femoris (NQF) (posteromedial), and superior gluteal nerve (SGN) (posterolateral). Techniques regarding peripheral nerve stimulation of the NQF are limited…

Sural Nerve

Introduction Chronic neuropathic pain of the lower extremity caused by sural nerve pathology is a rare reason for patients to seek medical attention. These pathologies have several underlying etiologies, and patients may have symptoms that limit their quality of life despite conservative therapy. Due to its uncommon occurrence, few clinicians have experience treating cases refractory to conservative measures, and there are few treatment options available for…

Posterior Tibial Nerve

Introduction Neuropathic pain is a common type of chronic pain that affects approximately 4.6% of the European population and 17.9% of Canada’s population. The estimated prevalence in the United States is 12.4%. Peripheral nerve stimulation (PNS) is a currently evolving method that is used to treat peripheral neuralgias that are resistant to other therapies. PNS is also used as an alternative to different medical treatments such…

Saphenous Nerve

Introduction Peripheral nerve stimulation (PNS) is an evolving neuromodulation modality that is used to treat chronic neuropathic pain in the distribution of a specific named nerve or branch of a named nerve. PNS continues to evolve, with the addition of multiple sites of stimulation and associated evidence. The saphenous nerve plays an important role in the treatment algorithm for chronic knee and foot/ankle pain. Patients suffering…

Peroneal Nerves (Fibular Nerves)

Clinical Presentation The peroneal nerves described in this chapter, which are also known as fibular nerves, are comprised of the common peroneal nerve (CPN), superficial peroneal nerve (SPN), and deep peroneal nerve (DPN) ( Fig. 27.1 ). The CPN (also known as the common fibular nerve, external popliteal nerve, and lateral popliteal nerve) is a branch of the sciatic nerve that separates from the tibial nerve…

Genicular Peripheral Nerve Stimulation

Introduction Peripheral nerve stimulation (PNS) is an effective neuromodulation modality for the treatment of chronic neuropathic pain in the distribution of specific peripheral nerves. Saphenous and genicular nerves play an important role in the treatment algorithm for chronic knee pain. Clinical Presentation Patients who are candidates for PNS of the knee may fall into two main categories: 1. Nociceptive pain that is chronic, leading to hypersensitization…

Femoral Nerve

Introduction The femoral nerve is the largest branch of the lumbar plexus and is comprised of branches from the L2 to L4 nerve roots. It is a mixed nerve with motor branches innervating hip flexors and knee extenders, as well as sensory branches innervating the hip, knee, and skin of the anteromedial leg. There are a variety of ways in which the nerve can be injured,…

Lateral Femoral Cutaneous Nerve

Introduction Compression of the lateral femoral cutaneous nerve (LFCN), referred to clinically as meralgia paresthetica, is a clinical syndrome in which patients report experiencing pain, discomfort, and dysesthesia throughout the distribution of sensory innervation of the nerve. The clinical syndrome of meralgia paresthetica is aptly named, as “meros” in Latin translates to thigh, while “algo” refers to pain. The LFCN does not have motor innervation and…

Pudendal Peripheral Nerve Stimulation For Chronic Pelvic Pain

Introduction Pudendal neuralgia (PN) is a painful condition resulting from inflammation, compression, or entrapment of the pudendal nerve. PN is one of the most disabling forms of genital pain, affecting approximately 4% of patients complaining of chronic pain. It has devastating effects on a patient’s quality of life, with serious limitations to their usual activities of daily living, particularly if sitting is involved. This is a…

Inferior Cluneal Nerve

Introduction The inferior cluneal nerve (ICN) is a branch of posterior femoral cutaneous nerve, which innervates the perineum ( Fig. 21.1 ). Although chronic neuropathic perineal pain is often attributed to pudendal neuropathy, there may be some cases where the pain is along the lateral anal margins, scrotum, or labia majora. Pain in the inferior and medial parts of the buttocks with some referral patterns along…

Middle Cluneal Nerves

Introduction The middle cluneal nerve (MCN) has long been overlooked as a cause of low back pain. As the understanding of the role of the MCN becomes more clear, the range of treatment options, including peripheral nerve stimulation (PNS), has increased. Clinical Presentation Pain caused by MCN entrapment (MCN-E) can often be overlooked during a patient’s initial presentation. The patient will complain of pain in the…

Superior Cluneal Nerves

Clinical Presentation The superior cluneal nerve (SCN) is a group of nerves that originate from the cutaneous branches of the dorsal rami of T11-L4 ( Fig. 19.1 ). Iwnaga et al.’s cadaveric dissection found that the nerve can arise from L5 as well. The SCN has often been overlooked as a cause of or contributor to lower back pain as well as buttocks and leg pain.…

Genitofemoral Nerve

Introduction Genitofemoral neuralgia is a syndrome characterized by chronic neuropathic pain along the distribution of the genitofemoral nerve (GFN). The pain and subsequent impairment to quality of life can be quite debilitating for patients suffering from this condition. Genitofemoral neuralgia is predominately reported as a result of iatrogenic nerve damage occurring during surgeries, trauma to the inguinal and femoral regions, and/or nerve entrapment. Failure to distinguish…

Ilioinguinal and Iliohypogastric Nerve

Introduction Ilioinguinal nerve (IIN) or iliohypogastric nerve (IHN) neuralgia is a frequent source of pain in the lower abdomen and upper thigh. It is common after lower abdominal surgery, particularly hernia surgery, or after injury to the abdominal wall. It presents with severe pain in the lower quadrant radiating to the groin and thigh. Patients are unable to engage their abdominal muscles; hence, their daily life…

Intercostal Nerves

Introduction Rib nerve pain, called intercostal neuralgia, causes a wide variety of clinical presentations. Although there are multiple causal mechanisms of the disease, the pain transmission pathways remain the same, leading to similarities in treatment approaches. Because intercostal neuralgia is a mononeuropathy with localized pain, peripheral nerve stimulation (PNS) is a useful treatment option. Clinical Presentation Intercostal neuralgia is neuropathic pain distributed along the affected intercostal…

Radial Nerve

Introduction Radial nerve pathology (such as radial tunnel [RT], posterior interosseous nerve entrapment, and superficial radial neuralgia) results in pain, with a reduced quality of life and function. Radial neuralgia is the third most common neuralgia of the upper extremity after the most common, median neuralgia (e.g., carpal tunnel syndrome [CTS]), followed by ulnar neuralgia (e.g., cubital tunnel syndrome). Radial neuralgia can be the cause of…

Median Nerve

Introduction With approximately 3,000 reported injuries per year in the United States, median nerve injuries are the primary cause of emergency room visitation for all peripheral nerve injuries. They can occur by multiple mechanisms, including (1) arm, elbow, and wrist lesions; (2) pronator syndrome; (3) carpal tunnel syndrome; and (4) anterior interosseous neuropathy. Carpal tunnel syndrome, however, represents the main clinical manifestation and has a 3%…

Ulnar Nerve

Introduction Ulnar neuropathy is relatively common and occurs either following an acute trauma or in the setting of a chronic compression of the nerve. In fact, ulnar nerve pathology is the most common reason for hospitalization compared with all other upper extremity neuropathies. Due to the rare occurrence of refractory ulnar neuropathic pain, there are limited treatment options once conservative management and surgical treatment have been…