title: Subcutaneous stimulation: how to assess optimal implantation depth.
abstract: BACKGROUND
  Subcutaneous stimulation (peripheral nerve field stimulation) is a novel neuromodulation modality that has increased in its utilization during the last 10 years. It consists of introducing a lead in the subdermal level to stimulate the small nerve fibers in that layer. Unlike other neuromodulation techniques including direct peripheral nerve stimulation, spinal cord stimulation, or deep brain stimulation, the precise target is not identified.
  
  
  METHODS
  To date, there is no clear guideline on the appropriate depth or a method to achieve reproducibility of the appropriate depth to place these leads. From clinical experience, we have found that when electrodes are placed in a layer that is too superficial, stimulation is often painful or lacks efficacy. Further, if they are too deep, the patient may not feel adequate paresthesia or get uncomfortable stimulation including, in some circumstances, muscle contractions.
  
  
  RESULTS
  In this small series, we demonstrate a novel concept using a radiofrequency stimulation probe to identify the appropriate depth to place the lead. Reproducibility of results will add clarity to the accumulating data and hopefully increase the chances of adequate stimulation coverage and pain relief.
authors: Hospital Universitario Puerta de Hierro Majadahonda, Madrid-Pain Unit, Madrid, Spain. dabejon@telefonica.net
authors: David
authors: D
authors: Abejón
authors: Timothy
authors: T
authors: Deer
authors: Paul
authors: P
authors: Verrills
mesh_terms: D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D010148:Intractable Pain / Q000628:therapy*