Peripheral nerve stimulation for the management of acute and subacute post-amputation pain: a randomized, controlled feasibility trial

Introduction & aim: Temporary (60-day) percutaneous peripheral nerve stimulation (PNS) has demonstrated effectiveness for the treatment of chronic post-amputation pain, and this pilot study aims to evaluate the feasibility of temporary percutaneous PNS for the treatment of acute post-amputation pain. Patients & methods: Sixteen veterans undergoing lower extremity amputation received PNS and standard medical therapy or standard medical therapy alone. Results: The PNS group reported greater reductions in average phantom limb pain, residual limb pain and daily opioid consumption, and there were fewer participants taking opioids through 3 months post-amputation. Conclusion: This pilot study suggests that PNS is feasible in the acute postoperative period following lower limb amputation and may provide a non-pharmacologic analgesic therapy that lowers pain scores and reduces opioid consumption, and thus warrants further investigation.

Download Full-text

Single perineural catheter for hybrid technique of combined peripheral nerve stimulation and regional local anesthetic nerve block to manage phantom limb pain: time to jump on the neuromodulation bandwagon?

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-103220 ◽

2021 ◽

pp. rapm-2021-103220

Author(s):

Jesse Miser ◽

Melinda Seering ◽

Rakesh V Sondekoppam ◽

Vivian H Y Ip ◽

Ban C H Tsui

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Local Anesthetic ◽

Nerve Stimulation ◽

Phantom Limb Pain ◽

Peripheral Nerve Stimulation ◽

Phantom Limb ◽

Hybrid Technique ◽

Limb Pain ◽

Perineural Catheter

Download Full-text

Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Pain Following Amputation

Military Medicine ◽

10.1093/milmed/usz114 ◽

2019 ◽

Vol 184 (7-8) ◽

pp. e267-e274 ◽

Cited By ~ 5

Author(s):

Steven P Cohen ◽

Christopher A Gilmore ◽

Richard L Rauck ◽

Denise D Lester ◽

Robert J Trainer ◽

...

Keyword(s):

Chronic Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Military Service ◽

Phantom Limb Pain ◽

Peripheral Nerve Stimulation ◽

Service Members ◽

Phantom Limb ◽

Limb Pain ◽

Military Service Members

Abstract Introduction Chronic pain and reduced function are significant problems for Military Service members and Veterans following amputation. Peripheral nerve stimulation (PNS) is a promising therapy, but PNS systems have traditionally been limited by invasiveness and complications. Recently, a novel percutaneous PNS system was developed to reduce the risk of complications and enable delivery of stimulation without surgery. Materials and Methods Percutaneous PNS was evaluated to determine if stimulation provides relief from residual and phantom limb pain following lower-extremity amputation. PNS leads were implanted percutaneously to deliver stimulation to the femoral and/or sciatic nerves. Patients received stimulation for up to 60 days followed by withdrawal of the leads. Results A review of recent studies and clinical reports found that a majority of patients (18/24, 75%) reported substantial (≥50%) clinically relevant relief of chronic post-amputation pain following up to 60 days of percutaneous PNS. Reductions in pain were frequently associated with reductions in disability and pain interference. Conclusions Percutaneous PNS can durably reduce pain, thereby enabling improvements in quality of life, function, and rehabilitation in individuals with residual or phantom limb pain following amputation. Percutaneous PNS may have additional benefit for Military Service members and Veterans with post-surgical or post-traumatic pain.

Download Full-text

Pilot Study in Temporary Peripheral Nerve Stimulation in Oncologic Pain

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13139 ◽

2020 ◽

Vol 23 (6) ◽

pp. 819-826 ◽

Cited By ~ 1

Author(s):

Ojas Mainkar ◽

Che Antonio Solla ◽

Grant Chen ◽

Aron Legler ◽

Amitabh Gulati

Keyword(s):

Pilot Study ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Peripheral Nerve Stimulation

Download Full-text

Percutaneous Peripheral Nerve Stimulation (Neuromodulation) for Postoperative Pain: A Randomized, Sham-controlled Pilot Study

Anesthesiology ◽

10.1097/aln.0000000000003776 ◽

2021 ◽

Author(s):

Brian M. Ilfeld ◽

Anthony Plunkett ◽

Alice M. Vijjeswarapu ◽

Robert Hackworth ◽

Sandeep Dhanjal ◽

...

Keyword(s):

Postoperative Pain ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Treatment Effect ◽

Rating Scale ◽

Pulse Generator ◽

Femoral Nerve ◽

Opioid Consumption ◽

Peripheral Nerve Stimulation ◽

Pain Scores

Background Percutaneous peripheral nerve stimulation is an analgesic technique involving the percutaneous implantation of a lead followed by the delivery of electric current using an external pulse generator. Percutaneous peripheral nerve stimulation has been used extensively for chronic pain, but only uncontrolled series have been published for acute postoperative pain. The current multicenter study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent clinical trial and (2) estimate the treatment effect of percutaneous peripheral nerve stimulation on postoperative pain and opioid consumption. Methods Preoperatively, an electrical lead was percutaneously implanted to target the sciatic nerve for major foot/ankle surgery (e.g., hallux valgus correction), the femoral nerve for anterior cruciate ligament reconstruction, or the brachial plexus for rotator cuff repair, followed by a single injection of long-acting local anesthetic along the same nerve/plexus. Postoperatively, participants were randomized to 14 days of either electrical stimulation (n = 32) or sham stimulation (n = 34) using an external pulse generator in a double-masked fashion. The dual primary treatment effect outcome measures were (1) cumulative opioid consumption (in oral morphine equivalents) and (2) mean values of the “average” daily pain scores measured on the 0 to 10 Numeric Rating Scale within the first 7 postoperative days. Results During the first 7 postoperative days, opioid consumption in participants given active stimulation was a median (interquartile range) of 5 mg (0 to 30) versus 48 mg (25 to 90) in patients given sham treatment (ratio of geometric means, 0.20 [97.5% CI, 0.07 to 0.57]; P < 0.001). During this same period, the average pain intensity in patients given active stimulation was a mean ± SD of 1.1 ± 1.1 versus 3.1 ± 1.7 in those given sham (difference, −1.8 [97.5% CI, −2.6 to −0.9]; P < 0.001). Conclusions Percutaneous peripheral nerve stimulation reduced pain scores and opioid requirements free of systemic side effects during at least the initial week after ambulatory orthopedic surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Download Full-text

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.

Download Full-text

Package Architecture and Component Design for an Implantable Peripheral Nerve Stimulation and Recording System for Advanced Prosthetics

International Symposium on Microelectronics ◽

10.4071/isom-2016-wa12 ◽

2016 ◽

Vol 2016 (1) ◽

pp. 000144-000150

Author(s):

Caroline K. Bjune ◽

John R. Lachapelle ◽

Andrew Czarnecki ◽

Alexander L. Kindle ◽

John R. Burns ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Stimulation ◽

Sensory Feedback ◽

Hand Movement ◽

Phantom Limb Pain ◽

Sensory Stimulation ◽

Peripheral Nerve Stimulation ◽

Phantom Limb ◽

Component Design ◽

Nerve Electrodes

Abstract One of the limitation of current prosthetics is the ability to provide sensory feedback to the human user. Due to this constraint, approximately 60–80 percent of amputees experience a phenomenon known as phantom limb pain, an ongoing painful sensations that to the individual, seems to be coming from the part of the limb that is no longer there. The lack of sensory feedback also limits the intuitive control of the user's hand movement, i.e. sense of grip or position. To address these limitations, we created am implantable system that could provide peripheral nerve stimulation, recording and motor control. The architecture of our Sensory-Stimulation Lead (SSL) system consist of multiple satellites connected to Draper's custom designed nerve electrodes. In this phase of the design, the implanted system is connected to a controller via percutaneous connections. The active electronics of the satellite is enclosed in a hermetic package approximately 14mm in diameter and less than 5mm thick. A custom ceramic feedthrough substrate provides the electrical connections of the internal electronics board to both the nerve electrodes and percutaneous leads. In this paper, we will describe the various packaging components of the system and the design, fabrication, and assembly considerations that drove our technology choices.

Download Full-text