Needle infiltration assisted explantation technique for peripheral nerve stimulator leads.

INTRODUCTION: Peripheral nerve stimulation is a neuromodulation modality that is increasing used to treat chronic pain. The permanent peripheral nerve stimulator systems, while easy to place are designed to stay in place and scar at the implantation site. There is a paucity of literature on explantation techniques for peripheral nerve stimulators. METHODS: In this report describe a needle infiltration assisted technique for lead explantation. This novel technique is minimally invasive, cost effective and utilizes a combination of fluoroscopy and ultrasound imaging. We describe the successful use of this technique in 3 cases in our practice without any adverse events. CONCLUSION: There are many situations which might require a permanent peripheral nerve stimulator to be explanted such as infection, lead erosion, patient request or need for patient to undergo magnetic resonance imaging (MRI). In these scenarios, we propose a novel needle infiltration assisted technique of explantation that is safe, effective and easy to replicate.

mTOR, a new potential target for chronic pain and opioid-induced tolerance and hyperalgesia.

Chronic pain is a major public health problem with limited treatment options. Opioids remain a routine treatment for chronic pain, but extended exposure to opioid therapy can produce opioid tolerance and hyperalgesia. Although the mechanisms underlying chronic pain, opioid-induced tolerance, and opioid-induced hyperalgesia remain to be uncovered, mammalian target of rapamycin (mTOR) is involved in these disorders. The mTOR complex 1 and its triggered protein translation are required for the initiation and maintenance of chronic pain (including cancer pain) and opioid-induced tolerance/hyperalgesia. Given that mTOR inhibitors are FDA-approved drugs and an mTOR inhibitor is approved for the treatment of several cancers, these findings suggest that mTOR inhibitors will likely have multiple clinical benefits, including anticancer, antinociception/anti-cancer pain, and antitolerance/hyperalgesia. This paper compares the role of mTOR complex 1 in chronic pain, opioid-induced tolerance, and opioid-induced hyperalgesia.