title: Sandwich technique, peripheral nerve stimulation, peripheral field stimulation and hybrid stimulation for inguinal region and genital pain.
abstract: OBJECTIVE
  Ilioinguinal neuralgia (IG) and genitofemoral (GF) neuralgia following inguinal hernia repair is a chronic and debilitating neuropathic condition. Recently, peripheral nerve stimulation has become an effective and minimally invasive option for the treatment of refractory pain. Here we present a retrospective case series of six patients who underwent placement of peripheral nerve stimulation electrodes using various techniques for treatment of refractory post-intervention inguinal region pain.
  
  
  METHODS
  Six patients with post-intervention inguinal, femoral or GF neuropathic pain were evaluated for surgery. Either octopolar percutaneous electrodes or combination of paddle and percutaneous electrodes were implanted in the area of their pain. Pain visual analog scores (VAS), surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of satisfaction with this therapy was assessed.
  
  
  RESULTS
  All six patients had an average improvement of 62% in the immediate post-operative follow-up. Four patients underwent stimulation for IG, one for femoral neuralgia, and another for GF neuralgia. Peripheral nerve stimulation provided at least 50% pain relief in all the six patients with post-intervention inguinal region pain. 85% of patients indicated they were completely satisfied with the therapy overall. There was one treatment failure with an acceptable complication rate.
  
  
  CONCLUSIONS
  Peripheral nerve or field stimulation for post-intervention inguinal region pain is a safe and effective treatment for this refractory and complex problem for patients who have exhausted other management options.
authors.affiliation: a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Shaw
authors.affiliation: a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA.
authors.forename: Mayur
authors.initials: M
authors.lastname: Sharma
authors.affiliation: a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA.
authors.forename: Zion
authors.initials: Z
authors.lastname: Zibly
authors.affiliation: a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ikeda
authors.affiliation: a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA.
authors.forename: Milind
authors.initials: M
authors.lastname: Deogaonkar
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005835:Genitalia; D006552:Hernia, Inguinal / Q000150:complications* / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D007264:Inguinal Canal; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain; D010149:Postoperative Pain / Q000628:therapy*; D010525:Peripheral Nerves; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Genitofemoral neuralgia; inguinal neuralgia; inguinal pain; peripheral nerve stimulation; testicular pain