title: Novel High-Frequency Peripheral Nerve Stimulator Treatment of Refractory Postherpetic Neuralgia: A Brief Technical Note.
abstract: OBJECTIVE
  The study aims to describe an ultrasound (US)-guided peripheral nerve stimulation implant technique and describe the effect of high-frequency peripheral nerve stimulation on refractory postherpetic neuralgia.
  
  
  METHODS
  Following a cadaver pilot trial using US and confirmatory fluoroscopic guidance, a 52-year-old man with refractory left supraorbital neuralgia underwent combined US and fluoroscopic-guided supraorbital peripheral nerve stimulator trial. The patient was subsequently implanted with a percutaneous lead over the left supraorbital and supratrochlear nerve utilizing a high-frequency stimulation paradigm.
  
  
  RESULTS
  At 9 months follow-up, the pain intensity had declined from a weekly average of 8/10 to 1/10 on the pain visual analog scale (VAS). After implant, both nerve conduction and blink reflex studies were performed, which demonstrated herpetic nerve damage and frequency-specific peripheral nerve stimulation effects. The patient preferred analgesia in the supraorbital nerve distribution accomplished with high-frequency paresthesia-free stimulation (HFS) at an amplitude of 6.2 mA, a frequency of 100-1200 Hz, and a pulse width of 130 μsec, to paresthesia-mediated pain relief associated with low-frequency stimulation.
  
  
  CONCLUSIONS
  We report the implant of a supraorbital peripheral nerve stimulating electrode that utilizes a high-frequency program resulting in sustained suppression of intractable postherpetic neuralgia.
authors.affiliation: University of California San Diego, San Diego, CA, USA.
authors.forename: Imanuel R
authors.initials: IR
authors.lastname: Lerman
authors.affiliation: University of California San Diego, San Diego, CA, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Chen
authors.affiliation: University of California San Diego, San Diego, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hiller
authors.affiliation: Western Reserve Hospital, Cuyahoga Falls, OH, USA.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Souzdalnitski
authors.affiliation: University of California San Diego, San Diego, CA, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Sheean
authors.affiliation: University of California San Diego, San Diego, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Wallace
authors.affiliation: University of California San Diego, San Diego, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Barba
mesh_terms: D001767:Blinking / Q000502:physiology; D002102:Cadaver; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D051474:Neuralgia, Postherpetic / Q000628:therapy*; D010147:Pain Measurement; D010525:Peripheral Nerves / Q000502:physiology*; D014463:Ultrasonography
keywords: Blink reflex; cadaver study; case report; chronic pain; herpes zoster; high frequency; nerve conduction study; neuromodulation; neuropathic pain; peripheral nerve stimulation; postherpetic neuralgia; shingles; supraorbital neuralgia; technical report