Cross Talk: A New Method for Peripheral Nerve Stimulation. An Observational Report with Cadaveric Verification

Background: Relief of regional, non-appendicular pain, particularly low back pain, throughspinal cord stimulation (SCS) has proven challenging. Recently, peripheral nerve stimulation(PNS), also known as peripheral nerve field stimulation (PNFS) depending on the stimulationarea, has demonstrated efficacy for the treatment of well-localized, small areas of pain involvingthe abdomen, inguinal region, pelvis, face, occipital area, and low back. More widespreadapplication of peripheral nerve stimulation has been limited by its narrow field of coverage in alarger group of patients with diffuse or poorly localized pain.Objectives: To determine if cross talk (the creation of an electrical circuit and therefore electricalstimulation between separate subcutaneously placed PNS leads [i.e. inter-lead stimulation]) wasclinically possible across large painful areas, assess the breadth of stimulation coverage via crosstalk, evaluate the clinical efficacy of peripheral nerve stimulation cross talk (PNSCT), and confirmthe existence of cross talk across a large area in a cadaveric model.Study Design: Case series observational report and cadaveric experimentation.Setting: A private, comprehensive interventional pain management practice with painmedicine fellowship training in the United States.Methods: Eighteen consecutive patients with non-appendicular, regional pain were included inthe study. Data collection for the implanted patients included the presence or absence of stimulationbetween the PNS leads, stimulation tolerability, stimulation region, lead orientation, lead montage,inter-lead distance, and pain relief from PNSCT compared to PNS without cross talk.A cadaveric analysis was performed to determine the presence or absence of an electrical circuitwith 2 subcutaneously PNS leads to confirm or refute the existence of electrical stimulation fromon lead to the other within subcutaneous fat with the leads placed at a significant distance apartfrom one another.Results: All 18 patients experienced significant pain relief, reduction of pain medication, andfunctional improvement. Cadaveric experimentation confirmed the presence of an electricalcircuit with PNS leads placed at a distance far apart from one another and verified that interlead stimulation (cross talk) does occur in subcutaneous fat over a great distance.Limitations: This study was limited by its small sample size, and the short-term follow-upafter implantation.Conclusions: The use of the PNSCT technique allows for significant analgesia for large painfulareas that have been poorly captured using traditional SCS techniques and not considered as anoption with the current application of peripheral nerve stimulation.Key words: Peripheral nerve stimulation, peripheral nerve field stimulation, cross talk, spinalcord stimulation, neuromodulation, low back pain, failed back surgery syndrome, abdominalpain, neck pain, post herpetic neuralgia, occipital headaches