Peripheral nerve stimulation
First Claim
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1. A method of stimulating to treat pain emanating from at least one peripheral nerve of a patient, the method comprising:
- percutaneously placing with a tubular introducer at least one electrode in subcutaneous tissue entirely superficial to the fascia and muscle layer, but below the skin, without further dissection, across a trunk of the peripheral nerve that is causing pain, applying electrical stimulation of a predetermined level to the at least one peripheral nerve with the at least one entire electrode in the subcutaneous tissue to cause paresthesia of the painful area, said at least one electrode being sufficiently distant from the at least one peripheral nerve to preclude either a burning sensation or muscular contractions noticeable by the patient when applying said electrical stimulation.
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Abstract
An apparatus for treating pain by electrical stimulation is disclosed. A lead is placed subcutaneously in the region of pain. The subcutaneous tissue is electrically stimulated to cause paresthesia. The method encompasses subcutaneous placement of an electrical lead near the region of pain and subsequent electrical stimulation of the tissue to cause paresthesia. In particular, an apparatus for treating intractable occipital neuralgia using percutaneous electrostimulation techniques is disclosed.
81 Citations
34 Claims
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1. A method of stimulating to treat pain emanating from at least one peripheral nerve of a patient, the method comprising:
- percutaneously placing with a tubular introducer at least one electrode in subcutaneous tissue entirely superficial to the fascia and muscle layer, but below the skin, without further dissection, across a trunk of the peripheral nerve that is causing pain, applying electrical stimulation of a predetermined level to the at least one peripheral nerve with the at least one entire electrode in the subcutaneous tissue to cause paresthesia of the painful area, said at least one electrode being sufficiently distant from the at least one peripheral nerve to preclude either a burning sensation or muscular contractions noticeable by the patient when applying said electrical stimulation.
- View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A method of stimulating an occipital nerve to treat occipital neuralgia, the method comprising:
- (a) percutaneously placing with an introducer needle at least one electrode in subcutaneous tissue entirely superficial to the fascia and muscle layer, but below the skin, without further dissection, across a trunk of the occipital nerve that is causing pain;
applying pulse energy to the at least one electrode; and
determining from the patient whether stimulated paresthesia of the painful area has occurred without an attendant burning sensation or muscular contractions noticeable by the patient upon application of the pulse energy. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20)
- (a) percutaneously placing with an introducer needle at least one electrode in subcutaneous tissue entirely superficial to the fascia and muscle layer, but below the skin, without further dissection, across a trunk of the occipital nerve that is causing pain;
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21. A method of stimulating at least one peripheral nerve to treat neuralgias emanating from the at least one peripheral nerve, the method comprising:
(a) percutaneously placing through an introducer needle at least one electrode in a patient'"'"'s subcutaneous tissue at a location entirely superficial to the fascia and muscle layer, but below the skin, without further dissection, across a trunk of the at least one peripheral nerve that is causing pain, providing electrical stimulation to the at least one peripheral nerve with the at least one electrode in the subcutaneous tissue, determining from the patient whether paresthesia of the painful area has resulted without an attendant burning sensation or muscular contractions noticeable by the patient when applying the electrical stimulation. - View Dependent Claims (22)
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23. A method of treating head pain comprising percutaneously placing at least one electrode in the subcutaneous tissue such that it is entirely superficial to muscle and fascia layers but below the skin, without further dissection across a trunk of a nerve, and a predetermined distance from the nerve located adjacent a part of a skull causing head pain;
- providing pulses of an electrical current to the at least one electrode;
determining from the patient whether a sensation of head pain is reduced without causing either a burning sensation or muscular contractions noticeable by the patient, and adjusting the predetermined distance and the electrical current pulses until the head pain is reduced without an attendant burning sensation or muscle contraction upon application of the electrical current pulses. - View Dependent Claims (24, 25, 26)
- providing pulses of an electrical current to the at least one electrode;
- 27. A method of treating pain in an area of the body of a patient, the method comprising identifying an area of pain innervated by at least one peripheral nerve, and percutaneously implanting a lead having a plurality of electrodes through a needle introducer such that said electrodes are placed in a patient'"'"'s subcutaneous tissue in the area entirely superficial to the fascia and muscle layer, but below the skin, without further dissection, across a trunk of the at least one peripheral nerve applying electrical pulses to at least one electrode of the plurality of electrodes to supply electrical stimulation of a level effective to cause paresthesia of the area without an attendant burning sensation or muscular contractions noticeable by the patient when supplying the electrical stimulation.
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30. A method of treating pain, the method comprising:
identifying at least two areas of pain innervated by peripheral nerves, percutaneously implanting a first lead having at least one electrode such that each electrode of the first lead is placed in a patient'"'"'s subcutaneous tissue in a first area of pain so as to be entirely superficial to the fascia and muscle layer, but beneath the skin, without further dissection, across a trunk of a peripheral nerve innervating the first area providing electrical stimulation of a predetermined level to the first area using the at least one electrode on the first lead to disrupt pain in the first area and not cause either a burning sensation or muscular contractions noticeable by the patient; and
percutaneously implanting a second lead having at least one electrode such that each electrode of the second lead is placed in the subcutaneous tissue in a second area of pain each electrode of the second lead being entirely superficial to the fascia and muscle layer, but beneath the skin, without further dissection, across a trunk of a peripheral nerve innervating the second area such that providing electrical stimulation of a predetermined level to the second area using the at least one electrode on the second lead is effective to disrupt pain in the second area while not causing either a burning sensation or muscular contractions noticeable by the patient.- View Dependent Claims (31)
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32. A method of treating pain in an area of the body, the method comprising:
- identifying an area of pain innervated by at least one peripheral nerve, percutaneously implanting a lead having a plurality of electrodes such that said electrodes are placed in a patient'"'"'s subcutaneous tissue in the area so as to be entirely superficial to the muscle and fascia layers covering the at least one peripheral nerve, without further dissection across a trunk of the peripheral nerves, across a trunk of said peripheral nerve, and using at least one electrode of the plurality of electrodes to supply electrical stimulation of a level sufficient to cause paresthesia of the area, without attendant burning sensation or muscular contractions noticeable by the patient when applying the electrical stimulation.
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33. A method of treating pain using electrical stimulation, the method comprising:
- identifying at least two areas of pain innervated by peripheral nerves, implanting a first lead having at least one electrode such that each electrode of the first lead is placed in a patient'"'"'s subcutaneous tissue in a first area of pain without further dissection so as to be entirely superficial to the fascia and muscle layers covering the peripheral nerves innervating the first area;
percutaneously implanting a second lead having at least one electrode such that each electrode of the second lead is placed in the subcutaneous tissue in a second area of pain without further dissection so as to be entirely superficial to the fascia and muscle layers covering the peripheral nerves innervating the second area; and
supplying electrical stimulation to at least one electrode of the first lead and to at least one electrode of the second lead of a level sufficient to cause paresthesia disrupting the pain, wherein each of the electrodes to which such electrical stimulation is supplied is at a location which will not cause either a burning sensation or muscular contractions noticeable by the patient when the electrical stimulation is supplied.
- identifying at least two areas of pain innervated by peripheral nerves, implanting a first lead having at least one electrode such that each electrode of the first lead is placed in a patient'"'"'s subcutaneous tissue in a first area of pain without further dissection so as to be entirely superficial to the fascia and muscle layers covering the peripheral nerves innervating the first area;
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34. A method of treating pain in an area of the body, the method comprising:
- identifying nerves causing the pain, percutaneously implanting a lead having a plurality of electrodes through a tubular introducer such that said electrodes are placed below the skin and entirely in subcutaneous tissue superficial to the fascia and muscle layers covering the identified nerves without further dissection across a trunk of said identified nerves; and
providing electrical stimulation to the identified nerves with at least some of the plurality of electrodes sufficient to cause paresthesia of the painful area without causing an attendant burning sensation or muscular contractions noticeable by the patient when the electrical stimulation is applied.
- identifying nerves causing the pain, percutaneously implanting a lead having a plurality of electrodes through a tubular introducer such that said electrodes are placed below the skin and entirely in subcutaneous tissue superficial to the fascia and muscle layers covering the identified nerves without further dissection across a trunk of said identified nerves; and
Specification