Implanted Nerve Stimulation Devices May Need Just 60 Days for Sustained Pain Control

Patients who have chosen to treat chronic pain with implanted peripheral nerve stimulation no longer need to be tethered permanently to the device. According to findings from a study in amputees, placing the device for just 60 days resulted in sustained pain relief and functional improvements.

Christopher Gilmore, Brian Ilfeld, Joshua Rosenow, Sean Li, Mehul Desai, Corey Hunter, Antoun Nader, John Mak, Richard Rauck, Nathan Crosby, and Joseph Boggs received a Best of Meeting Abstract Award for their abstract of the study, “60-Day Percutaneous Peripheral Nerve Stimulation Implant Produces Sustained Relief of Chronic Pain in Amputees: 12-Month Follow-Up of a Double-Blind, Randomized, Placebo-Controlled Trial,” which will be presented on Thursday, November 14, 2019, during the 18th Annual Pain Medicine Meeting in New Orleans, LA.

Percutaneous peripheral nerve stimulation devices have been shown to effectively reduce postamputation chronic pain and restore functionality, but to date they have not been widely used, presumably because they required permanent placement through invasive procedures. To mitigate those barriers, Gilmore and colleagues investigated whether temporary placement for just 60 days would provide sustained therapeutic benefit.

Twenty-eight patients with lower-extremity amputations and residual limb pain or phantom limb pain were randomized to one of two treatment groups: (1) eight weeks of peripheral nerve stimulation or (2) four weeks of placebo with crossover to four weeks of peripheral nerve stimulation. They underwent ultrasound-guided implantation of percutaneous, fine-wire coiled peripheral nerve stimulation leads targeting the femoral and sciatic nerves. The leads were removed after the eight-week treatment period.

After 12 months of follow-up, patients in group 1 reported sustained pain relief (67%), reduced phantom limb pain (77%), reduced residual limb pain (64%), and reduced pain interference with activities of daily living (56%). Compared to group 2, patients in group 1 reported a larger decrease in depression symptoms (15% versus 8%).

“This work suggests that implantation of percutaneous peripheral nerve stimulation leads for up to 60 days may provide significant pain relief and subsequent functional improvements in patients that have suffered from chronic neuropathic and non-neuropathic symptoms for many years following amputation,” the researchers wrote. They attributed the results to the activation of large diameter sensory fibers that may reverse cortical nociceptive representation of pain.

The 18th Annual Pain Medicine Meeting will be held November 14–16, 2019, in New Orleans, LA. The conference brings together national and international experts in pain medicine to offer translational and clinical information that pain practitioners can implement directly in practice.

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