7.11 (9.9) Neurostimulation in pain management Flashcards
List three non invasive neurostimulation techniques
Transcutaneous electrical nerve stimulation (TENS)*
Transcutaneous vagus nerve stimulation (tVNS)*
Transcranial direct current stimulation (tDCS)*
Transcranial magnetic stimulation (TMS)
Cranial electrotherapy stimulation (CES)
List three invasive neurostimulation techniques
Spinal cord stimulation (SCS)*
Peripheral nerve stimulation (PNS)*
Deep brain stimulation (DBS)
Motor cortex stimulation (MCS)*
What does the gate control theory of pain suggest and how is this applied to neurostimulation techniques
Small fibre nociceptive signals can be inhibited by concurrent activation of large diameter non-nociceptive afferents
Neurostimulation allows for the activation of large diameter afferents to decrease pain signal transduction
List three neurotransmitters that are involved in the effects of TENS
-adenosine (caffeine blocks adenosine, can block the effect of TENS)
-endogenous opioid peptides
-encephalins
-dynorphins
Where are electrodes placed for each of the following stimulation techniques:
- Spinal cord stimulation (SCS)
- peripheral nerve stimulation (PNS)
- deep brain stimulation (DBS)
- motor cortex stimulation (MCS)
- Transcutaneous electrical nerve stimulation (TENS)
Spinal cord stimulation (SCS)
- Implantation of electrodes in the epidural space at the level of the posterior columns of the spinal cord
Peripheral nerve stimulation (PNS)
- Implantation of electrodes in the subcutaneous tissue over the peripheral nerve that innervates the affected area
Deep brain stimulation (DBS)
- Leads placed in deep brain structures
Motor cortex stimulation (MCS)
- Grid placed on the motor cortex
- 6th: electrodes sx implanted in eipidural space to deliver electric current to motor cortex
Transcutaneous electrical nerve stimulation (TENS)
- electrodes placed at painful area (6th: on skin) and stimulate underlying area
Table 9.9.1 5th Ed.
transcranial direct current stimulation
- how does it work
- name 1 benefit
Non-invasive technique that applies low-intensity direct current to the scalp.
The current penetrates the brain and modulates neuronal excitability and other neuroplastic changes.
Advantages:
decreased pain medication
5th Ed. answers below, not noted in 6th:
improved QOL
increased sleep efficiency
What makes transcranial magnetic stimulation (TMS) different from other neurostimulation techniques?
What three factors are felt to impact the efficacy of TMS?
Non-invasive technique where a powerful magnetic field is induced by an electromagnetic coil near the head leading to electrical current in underlying brain structures
Factors
- etiology of the pain
- location of the pain,
- where TMS is applied
(less effective in brainstem stroke; best results in facial pain as compared to upper and lower limbs)
List two contraindications for Deep brain stimulation (DBS)
- ventriculomegaly large enough to impede direct electrode placement
- irreversible coagulopathy
List three side effects of DBS not related to the stimulation itself
Device-related complications
- infections*
- electrode fracture or dislocation
- hardware failure*
Life-threatening complications
- intracranial haemorrhage *
- hematoma
- paralysis
Other
- perioperative haemorrhage,
List three side effects of DBS related to the stimulation
The symptom tends to correlate with the anatomical structure being stimulated, and can include:
- paraesthesias,*
- dysarthria*
- dyskinesia
- gait disturbances*
- imbalance, confusion
- depression
- inappropriate laughter
- mood /personality changes*
Name FOUR indications for spinal cord stimulation (SCS)
◆ Complex regional pain syndrome*
◆ Failed back sx syndrome
◆ Painful ischaemic disorder (eg peripheral vascular disease)
◆ Radiculopathies*
◆ Phantom Pain*
◆ Chronic serious illness (cancer, diabetes) + tx refrac pain w/ neuropathic component*
