PTNS Tibial nerve stim - Pain in big toe/foot -continence
Posted: Sat Jan 19, 2013 6:44 am
Found this on the chronicprostatitis.com forum. PTNS Post tibial nerve stim for urinary urgency, other issues..... Company Uroplasty Inc provides it to urologists throughout the country, may be mentioned elsewhere here. Probably worth a shot if ins pays .
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Some info on Post tibial nerve stimulation -- I believe there is a small study (much smaller than Stroller's initial work) posted elsewhere here by a small foreign university.
I became interested in ptns because Jill Osborne, founder of IC network in 1993 mentioned it in a post, participated in a study, and found favorable results. Otherwise I probably wouldn't have noticed it.
I also read somewhere that the tibial nerve innervates the tip of the penis and the ball of the foot (not sure this is correct). That and the concept many CPPS'ers complain of big toe/ball of foot pain peaked my interest. The twitching of the big toe is used as an indicator to correct probe placement for ptns.
Ptns uses nerve crosstalk to advantage. Instead of stimulating the nerves directly behind the sacrum, the tibial nerve, originating behind the sacrum is accessed about 3ft away where it nears the skin's surface around the anklebone. Stimulating this nerve will stimulate others originating near it from the sacrum, even 3 ft away.
Stroller developed this work at UCLA, for urinary urgency issues. Ms. Osborne credits it with helping her to "break the pain cycle", much as Webslave recommends Quercetin, etc to do. May be useful for other things than urgency.
In 2008, a company named uroplasty inc. developed a small system licensed to urologists around the country and it passed phase III FDA trials. The original Stroller experiments used simple TENS units, but there were additional issues as to pulse width etc. This system has been formalized by uroplasty.
For some of you on the borderline, trying to make headway past a sticking point it may prove useful. Especially if covered by insurance.
Some info on Ms. Osborne provided. Familiar to us all----- Graduate student, semi-pro tennis, one day they bombed the swimming pool with bromine/chlorine and years of fun following....
Maybe we can classify it for now as "Advanced shot in the dark"
----------------------------------------------------------------
MORE INFORMATION ON SANS
(May 2005)
A number of patients over the years have asked me to share my experience using the Stoller Afferent Nerve Stimulator (SANS) procedure. Also known as post-tibial nerve stimulation (PTNS), it was developed by Dr. Marshall Stoller at the UCSF Medical Center as an alternative to the more invasive Sacral Nerve Stimulation (SNS aka Interstim) that had also been developed at UCSF.
Dr. Stoller became interested in this while observing the difficulties patients experienced while doing SNS. Rather than requiring electrode placement in the sacrum which, at that time, was excruciating painful for those early Interstim patients, he suggested stimulating that same nerve where it was closest to the surface of the skin... which is just a few inches above the ankle. Using just an acupuncture needle as a vector to the nerve along with a basic TENS unit, Dr. Stoller discovered that he could also stimulate the nerve and create beneficial effects in the bladder and pelvis, most notably a dramatic improvement in blood flow in the region. You can read more about the theory of PTSN how SANS works in Dr. Stoller's guest lecture on our website!
I had roughly 30 treatments overall. For the first 10 treatments, I travelled to San Francisco to his office. First of all, let me just offer that this was the easiest, least painful therapy that I had ever tried. There was no disrobing, no catheters or fluids placed in my bladder. It was JUST a tiny, slim needle placed expertly (and at specific angles) above my ankle. Most of the time, I never felt it go in.
A TENS unit was then attached to the needle with a small adapter. It was then turned on and the intensity increased until I could feel the stimulation. It never hurt... it was more like a gentle pulsing. We always knew if the needle was in the right place because the stimulation would make my big toe flex downwards.
The TENS unit was kept on only on for 20 minutes per day. Dr. Stoller emphasized that "more was not always better" and, though I volunteered to keep it for much longer, he discouraged that. He didn't want to overstimulate the nerve. Also, FYI, it should never be painful. If it is, it should be turned down immediately.
RESULTS:
I believe that SANS helped to break me out of the vicious pain cycle that I had been in for so long. After my fourth treatment, I had my first two hours without pain. After my eighth treatment, I had my first day without pain and, from that moment, my IC just slowly and steadily improved. Of course, I had lots of flares too, mostly related to my own stupidity with diet. Modifying my diet and avoiding those triggers also played a huge role in my recovery.
After 10 treatments, I was taught to do this at home. I continued to use SANS for about a few years afterwards... first once a week, then once every two weeks, then once a month. I think that I last did it about six or seven years ago though I still have my kit and wouldn't hesitate to do it again were my pain and symptoms to get out of control once again. I have to say that last part of my recovery was also using the medication Vistaril (an antihistamine) which I began about two years later. It was the combination of diet, SANS and Vistaril that brought my IC under near complete control and gave me the ability to function normally again.
CORPORATE DELAYS:
Unfortunately, the company which was to bring SANS to market (aka Urosurge) went out of business thus creating a several year delay. (Dr. Stoller still performs this procedure in his office using simple TENS units.) One new company, Cystomedix, has created a similar device called URGENT PC which they received FDA approval for about two years ago. But, they just did not have the resources to bring the product to market. In late 2004, Cystomedix licensed Urgent PC to a new company, Uroplasty, Inc. On August 10, 2005, Uroplasty announced that they had submitted a new FDA application for the use of the device with Overactive Bladder. Finally, we have PROGRESS in bring this product to the patients who need it the most!
CONCLUSION:
Ultimately, SANS is a viable, affordable nerve stimulation procedure. I'm a strong advocate because I've seen so many patients have difficulty doing the more invasive sacral nerve stimulation. Aside from it's tremendous expense, the national, long term complication rate from SNS has yet to be published. As recently as July 2005, we've made yet another Freedom of Information Act requests for the data but have yet to receive it. (That's another story all together.)
Post tibial nerve stimulation is very affordable, requires no hospitalization, and has few risks. Of course, if you're stupid and put the device up too high, then it's your own fault, eh? Remember, this procedure should not hurt. If it does, it's not being done correctly. There have been a scattering of research studies on PTNS in the past few years, some of which found it helpful, others of which didn't. You can research those on the PUBMED service.
GRATITUDE:
I am extremely grateful to Dr. Stoller. When I walked into his office that very first time, he compassionately acknowledged not only my pain, but also my desperation in wanting to get better. He BELIEVED that I was suffering and made a commitment to try to help me. By treating me with SANS, he saved me from having an unnecessary surgical nerve stimulation procedure. I cannot tell you how lucky I am NOT to have been one of those early, experimental sacral nerve stimulation patients at UCSF, some of whom suffered horribly from their procedures.
----------------------------------
Re: Nerve Crosstalk -- PTNS vs Interstim
I don't know if its that well known. Since it is usually more recommended for i.c. urgency/urination pain it may be better known on those sites. I believe it was only recently (24 mo ago) approved by the FDA for phase III which means I think insurance will now pay for it. (probably $250/treatment with ins now) Some folks with perineal/genital/etc complaints may have to fib a bit with some urinary complaints to try it.
That said, I believe for now it is only licensed with urologists. Many men have been to so many uros and so turned off by the profession they may not look into it if Christ or Buddha recommended it.
--------------------------------------------------------------------------------
Re: Nerve Crosstalk -- PTNS vs Interstim
by kevin ยป Fri Oct 15, 2010 10:30 pm
I tried both PTNS and Interstim. Neither had any effect.
I thought I saw a paper here. Found it but it is a pretty small research institute.
http://www.chronicprostatitis.com/forum ... 513#p37513
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Re: Nerve Crosstalk -- PTNS vs Interstim
The firm Uroplasty Inc may be entering phase one trials of its URGENT PC -percutaneous tibial nerve stimulation device (ptns) for other types of incontinence than urinary. Currently it is available from participating urologists for urinary urgency and stress , urge ,mixed and overflow incontinence. Some guys may have tried it for perineal/pelvic pain. This device has pre programmed pulse widths, intensities etc as documented in Dr. Strollers original work at UCLA.
http://www.uroplasty.com/healthcare/urgentpc
http://www.youtube.com/watch?v=0drKILgxhiM
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy and mild dribbling after urination; pubic/prostate/perineal discomfort; Helped by: Afrin nasal spray, Cymbalta (these meds help me if taken 3 days straight), hydrocodone (small doses), distraction, eliminating wheat/gluten from diet. Makes worse: sex.
Your question has probably come up before. Please use the search function.
Not medical advice. Consult your doctor.
kevinRetired Mod
Posts: 460Joined: Mon Aug 02, 2004 10:23 pmLocation: USA
Top
----------------------------------------------------------------------------------------------------------
Some info on Post tibial nerve stimulation -- I believe there is a small study (much smaller than Stroller's initial work) posted elsewhere here by a small foreign university.
I became interested in ptns because Jill Osborne, founder of IC network in 1993 mentioned it in a post, participated in a study, and found favorable results. Otherwise I probably wouldn't have noticed it.
I also read somewhere that the tibial nerve innervates the tip of the penis and the ball of the foot (not sure this is correct). That and the concept many CPPS'ers complain of big toe/ball of foot pain peaked my interest. The twitching of the big toe is used as an indicator to correct probe placement for ptns.
Ptns uses nerve crosstalk to advantage. Instead of stimulating the nerves directly behind the sacrum, the tibial nerve, originating behind the sacrum is accessed about 3ft away where it nears the skin's surface around the anklebone. Stimulating this nerve will stimulate others originating near it from the sacrum, even 3 ft away.
Stroller developed this work at UCLA, for urinary urgency issues. Ms. Osborne credits it with helping her to "break the pain cycle", much as Webslave recommends Quercetin, etc to do. May be useful for other things than urgency.
In 2008, a company named uroplasty inc. developed a small system licensed to urologists around the country and it passed phase III FDA trials. The original Stroller experiments used simple TENS units, but there were additional issues as to pulse width etc. This system has been formalized by uroplasty.
For some of you on the borderline, trying to make headway past a sticking point it may prove useful. Especially if covered by insurance.
Some info on Ms. Osborne provided. Familiar to us all----- Graduate student, semi-pro tennis, one day they bombed the swimming pool with bromine/chlorine and years of fun following....
Maybe we can classify it for now as "Advanced shot in the dark"
----------------------------------------------------------------
MORE INFORMATION ON SANS
(May 2005)
A number of patients over the years have asked me to share my experience using the Stoller Afferent Nerve Stimulator (SANS) procedure. Also known as post-tibial nerve stimulation (PTNS), it was developed by Dr. Marshall Stoller at the UCSF Medical Center as an alternative to the more invasive Sacral Nerve Stimulation (SNS aka Interstim) that had also been developed at UCSF.
Dr. Stoller became interested in this while observing the difficulties patients experienced while doing SNS. Rather than requiring electrode placement in the sacrum which, at that time, was excruciating painful for those early Interstim patients, he suggested stimulating that same nerve where it was closest to the surface of the skin... which is just a few inches above the ankle. Using just an acupuncture needle as a vector to the nerve along with a basic TENS unit, Dr. Stoller discovered that he could also stimulate the nerve and create beneficial effects in the bladder and pelvis, most notably a dramatic improvement in blood flow in the region. You can read more about the theory of PTSN how SANS works in Dr. Stoller's guest lecture on our website!
I had roughly 30 treatments overall. For the first 10 treatments, I travelled to San Francisco to his office. First of all, let me just offer that this was the easiest, least painful therapy that I had ever tried. There was no disrobing, no catheters or fluids placed in my bladder. It was JUST a tiny, slim needle placed expertly (and at specific angles) above my ankle. Most of the time, I never felt it go in.
A TENS unit was then attached to the needle with a small adapter. It was then turned on and the intensity increased until I could feel the stimulation. It never hurt... it was more like a gentle pulsing. We always knew if the needle was in the right place because the stimulation would make my big toe flex downwards.
The TENS unit was kept on only on for 20 minutes per day. Dr. Stoller emphasized that "more was not always better" and, though I volunteered to keep it for much longer, he discouraged that. He didn't want to overstimulate the nerve. Also, FYI, it should never be painful. If it is, it should be turned down immediately.
RESULTS:
I believe that SANS helped to break me out of the vicious pain cycle that I had been in for so long. After my fourth treatment, I had my first two hours without pain. After my eighth treatment, I had my first day without pain and, from that moment, my IC just slowly and steadily improved. Of course, I had lots of flares too, mostly related to my own stupidity with diet. Modifying my diet and avoiding those triggers also played a huge role in my recovery.
After 10 treatments, I was taught to do this at home. I continued to use SANS for about a few years afterwards... first once a week, then once every two weeks, then once a month. I think that I last did it about six or seven years ago though I still have my kit and wouldn't hesitate to do it again were my pain and symptoms to get out of control once again. I have to say that last part of my recovery was also using the medication Vistaril (an antihistamine) which I began about two years later. It was the combination of diet, SANS and Vistaril that brought my IC under near complete control and gave me the ability to function normally again.
CORPORATE DELAYS:
Unfortunately, the company which was to bring SANS to market (aka Urosurge) went out of business thus creating a several year delay. (Dr. Stoller still performs this procedure in his office using simple TENS units.) One new company, Cystomedix, has created a similar device called URGENT PC which they received FDA approval for about two years ago. But, they just did not have the resources to bring the product to market. In late 2004, Cystomedix licensed Urgent PC to a new company, Uroplasty, Inc. On August 10, 2005, Uroplasty announced that they had submitted a new FDA application for the use of the device with Overactive Bladder. Finally, we have PROGRESS in bring this product to the patients who need it the most!
CONCLUSION:
Ultimately, SANS is a viable, affordable nerve stimulation procedure. I'm a strong advocate because I've seen so many patients have difficulty doing the more invasive sacral nerve stimulation. Aside from it's tremendous expense, the national, long term complication rate from SNS has yet to be published. As recently as July 2005, we've made yet another Freedom of Information Act requests for the data but have yet to receive it. (That's another story all together.)
Post tibial nerve stimulation is very affordable, requires no hospitalization, and has few risks. Of course, if you're stupid and put the device up too high, then it's your own fault, eh? Remember, this procedure should not hurt. If it does, it's not being done correctly. There have been a scattering of research studies on PTNS in the past few years, some of which found it helpful, others of which didn't. You can research those on the PUBMED service.
GRATITUDE:
I am extremely grateful to Dr. Stoller. When I walked into his office that very first time, he compassionately acknowledged not only my pain, but also my desperation in wanting to get better. He BELIEVED that I was suffering and made a commitment to try to help me. By treating me with SANS, he saved me from having an unnecessary surgical nerve stimulation procedure. I cannot tell you how lucky I am NOT to have been one of those early, experimental sacral nerve stimulation patients at UCSF, some of whom suffered horribly from their procedures.
----------------------------------
Re: Nerve Crosstalk -- PTNS vs Interstim
I don't know if its that well known. Since it is usually more recommended for i.c. urgency/urination pain it may be better known on those sites. I believe it was only recently (24 mo ago) approved by the FDA for phase III which means I think insurance will now pay for it. (probably $250/treatment with ins now) Some folks with perineal/genital/etc complaints may have to fib a bit with some urinary complaints to try it.
That said, I believe for now it is only licensed with urologists. Many men have been to so many uros and so turned off by the profession they may not look into it if Christ or Buddha recommended it.
--------------------------------------------------------------------------------
Re: Nerve Crosstalk -- PTNS vs Interstim
by kevin ยป Fri Oct 15, 2010 10:30 pm
I tried both PTNS and Interstim. Neither had any effect.
I thought I saw a paper here. Found it but it is a pretty small research institute.
http://www.chronicprostatitis.com/forum ... 513#p37513
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Re: Nerve Crosstalk -- PTNS vs Interstim
The firm Uroplasty Inc may be entering phase one trials of its URGENT PC -percutaneous tibial nerve stimulation device (ptns) for other types of incontinence than urinary. Currently it is available from participating urologists for urinary urgency and stress , urge ,mixed and overflow incontinence. Some guys may have tried it for perineal/pelvic pain. This device has pre programmed pulse widths, intensities etc as documented in Dr. Strollers original work at UCLA.
http://www.uroplasty.com/healthcare/urgentpc
http://www.youtube.com/watch?v=0drKILgxhiM
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy and mild dribbling after urination; pubic/prostate/perineal discomfort; Helped by: Afrin nasal spray, Cymbalta (these meds help me if taken 3 days straight), hydrocodone (small doses), distraction, eliminating wheat/gluten from diet. Makes worse: sex.
Your question has probably come up before. Please use the search function.
Not medical advice. Consult your doctor.
kevinRetired Mod
Posts: 460Joined: Mon Aug 02, 2004 10:23 pmLocation: USA
Top
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