Subcutaneous stimulation of named and unnamed branches of nerves in the area of pain has been found to be therapeutic and has generated a number of interesting therapies. Occipital nerve stimulation is one such technique that will have a great future in transforming severe headache management such as migraine, cluster headache and hemicrania continua. Electrodes are threaded subcutaneously unilaterally or bilaterally at the level of the nuchal line from midline to above mastoid so picking up the branches of occipital nerves. Other peripheral nerves such as ilioinguinal and genitofemoral can also be subcutaneously stimulated in this way and used in post-surgical traumatic neuropathies after groin or gynaecological surgery.
Low back pain can also be treated by placing transverse electrodes in the low back, presumably stimulating perforating cutaneous nerve branches. This can even be combined with SCS to optimise back coverage in those difficult to achieve with SCS alone. Clinically anecdotal work supports the notion that many localised but difficult to treat chronic pains may be helped by peripheral field nerve stimulation techniques. This is an area to watch as it develops.
Simon Thomson, M. F. (2013, March 12). Spinal Cord Stimulation for Neuropathic Pain. Retrieved January 9, 2013, from International Neuromodulation Society: http://www.neuromodulation.com