Percutaneous Peripheral Nerve Stimulation for Chronic Pain in Subacromial Impingement Syndrome: A Case Series

Abstract Orthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy—percutaneous peripheral nerve stimulation (PNS) – and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.

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Mechanism of Peripheral Nerve Stimulation in Chronic Pain

Pain Medicine ◽

10.1093/pm/pnaa164 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

pp. S6-S12 ◽

Cited By ~ 1

Author(s):

Tiffany Lin ◽

Akshat Gargya ◽

Harmandeep Singh ◽

Eellan Sivanesan ◽

Amitabh Gulati

Keyword(s):

Chronic Pain ◽

Literature Review ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Peripheral Nerve Stimulation ◽

Cochrane Library ◽

Gate Control Theory ◽

Comprehensive Literature Review ◽

Gate Control ◽

Chronic Pain Conditions

Abstract Introduction With the advancement of technology, peripheral nerve stimulation (PNS) has been increasingly used to treat various chronic pain conditions. Its origin is based on the gate control theory postulated by Wall and Melzack in 1965. However, the exact mechanism behind PNS’ analgesic effect is largely unknown. In this article, we performed a comprehensive literature review to overview the PNS mechanism of action. Design A comprehensive literature review on the mechanism of PNS in chronic pain. Methods Comprehensive review of the available literature on the mechanism of PNS in chronic pain. Data were derived from database searches of PubMed, Scopus, and the Cochrane Library and manual searches of bibliographies and known primary or review articles. Results Animal, human, and imaging studies have demonstrated the peripheral and central analgesic mechanisms of PNS by modulating the inflammatory pathways, the autonomic nervous system, the endogenous pain inhibition pathways, and involvement of the cortical and subcortical areas. Conclusions Peripheral nerve stimulation exhibits its neuromodulatory effect both peripherally and centrally. Further understanding of the mechanism of PNS can help guide stimulation approaches and parameters to optimize the use of PNS.

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Ultrasound-Guided Peripheral Nerve Stimulation for Knee Pain: A Mini-Review of the Neuroanatomy and the Evidence from Clinical Studies

Pain Medicine ◽

10.1093/pm/pnz318 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

pp. S56-S63

Author(s):

Chih-Peng Lin ◽

Ke-Vin Chang ◽

Wei-Ting Wu ◽

Levent Özçakar

Keyword(s):

Peripheral Nerve ◽

Knee Pain ◽

Nerve Stimulation ◽

Case Reports ◽

Case Series ◽

Peripheral Nerve Stimulation ◽

Present Review ◽

Chronic Knee Pain ◽

Catheter Dislodgement ◽

Continuous Nerve Block

Abstract Objectives Peri- and postoperative pain frequently develops after joint replacement for severe knee osteoarthritis. A continuous nerve block is commonly used for pain relief, but the risks of infection and catheter dislodgement should be considered. The present mini-review aimed to brief the innervation and neural sonoanatomy of the knee joint and summarize the newest evidence of peripheral nerve stimulation (PNS) use in the management of knee pain. Methods We used a systematic approach to search for relevant articles. We used the combination of “peripheral nerve stimulation” and “knee pain” as the key words for the literature search using the electronic database without language or article type restriction. The search period was from the earliest record to August 2019. Results The present review identified six studies, four of which were related to PNS for management of postoperative knee pain and two of which probed neuropathic pain. Most of the studies were either case series or case reports. Based on our search result, PNS is likely to be a feasible and safe treatment for knee pain, but its effectiveness remains uncertain. Conclusions The present review reveals that PNS is feasible for the management of knee pain, especially in the postoperative period. The procedure is safe under ultrasound guidance used for proper placement of the electrodes near the target nerves. In the future, more prospective randomized controlled trials are needed to validate the effectiveness of PNS in acute and chronic knee pain.

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Fully Implantable Peripheral Nerve Stimulation for Hemiplegic Shoulder Pain: A Multi-Site Case Series With Two-Year Follow-Up

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.12726 ◽

2017 ◽

Vol 21 (3) ◽

pp. 290-295 ◽

Cited By ~ 12

Author(s):

Richard D. Wilson ◽

Maria E. Bennett ◽

Vu Q.C. Nguyen ◽

William C. Bock ◽

Michael W. O'Dell ◽

...

Keyword(s):

Peripheral Nerve ◽

Shoulder Pain ◽

Nerve Stimulation ◽

Case Series ◽

Peripheral Nerve Stimulation

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Peripheral Nerve Stimulation for Chronic Pain: A Systematic Review of Effectiveness and Safety

Pain and Therapy ◽

10.1007/s40122-021-00306-4 ◽

2021 ◽

Author(s):

Standiford Helm ◽

Nikita Shirsat ◽

Aaron Calodney ◽

Alaa Abd-Elsayed ◽

David Kloth ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Peripheral Nerve Stimulation

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Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/27 ◽

2012 ◽

Vol 1;15 (1;1) ◽

pp. 27-33 ◽

Cited By ~ 1

Author(s):

David A. Stidd

Keyword(s):

Neuropathic Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Medical Management ◽

Facial Pain ◽

Case Series ◽

Peripheral Nerve Stimulation ◽

Intractable Pain ◽

Safe Procedure ◽

Trigeminal Neuropathic Pain

Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can be a condition difficult to adequately treat with medical management alone. Patients with TNP can suffer from significant morbidity as a result of inadequate treatment or the side effects of pharmacologic therapy. TNP refractory to medical management can be considered for treatment with a growing number of invasive procedures. Peripheral nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively treat medically intractable TNP. We present a case series of common causes of TNP successfully treated with PNS with up to a 2 year follow-up. Only one patient required implantation of new electrode leads secondary to electrode migration. The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management. Key words: Trigeminal neuropathic pain, peripheral nerve stimulation, neuromodulation, intractable pain, facial trauma, postherpetic neuralgia

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Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-100937 ◽

2019 ◽

Vol 45 (1) ◽

pp. 44-51 ◽

Cited By ~ 4

Author(s):

Christopher A Gilmore ◽

Brian M Ilfeld ◽

Joshua M Rosenow ◽

Sean Li ◽

Mehul J Desai ◽

...

Keyword(s):

Chronic Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Short Form ◽

Peripheral Nerve Stimulation ◽

Pain Interference ◽

Phantom Limb ◽

Group 2 ◽

Group 1

IntroductionPeripheral nerve stimulation (PNS) has historically been used to treat chronic pain, but generally requires implantation of a permanent system for sustained relief. A recent study found that a 60-day PNS treatment decreases post-amputation pain, and the current work investigates longer-term outcomes out to 12 months in the same cohort.MethodsAs previously reported, 28 traumatic lower extremity amputees with residual and/or phantom limb pain were randomized to receive 8 weeks of PNS (group 1) or 4 weeks of placebo followed by a crossover 4 weeks of PNS (group 2). Percutaneous leads were implanted under ultrasound guidance targeting the femoral and sciatic nerves. During follow-up, changes in average pain and pain interference were assessed using the Brief Pain Inventory–Short Form and comparing with baseline.ResultsSignificantly more participants in group 1 reported ≥50% reductions in average weekly pain at 12 months (67%, 6/9) compared with group 2 at the end of the placebo period (0%, 0/14, p=0.001). Similarly, 56% (5/9) of participants in group 1 reported ≥50% reductions in pain interference at 12 months, compared with 2/13 (15%, p=0.074) in group 2 at crossover. Reductions in depression were also statistically significantly greater at 12 months in group 1 compared with group 2 at crossover.ConclusionsThis work suggests that percutaneous PNS delivered over a 60-day period may provide significant carry-over effects including pain relief, potentially avoiding the need for a permanently implanted system while enabling improved function in patients with chronic pain.Trial registration numberNCT01996254.

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