Pilot Study in Temporary Peripheral Nerve Stimulation in Oncologic Pain

Ojas Mainkar, Che Antonio Solla, Grant Chen, Aron Legler, Amitabh Gulati, Ojas Mainkar, Che Antonio Solla, Grant Chen, Aron Legler, Amitabh Gulati

Abstract

Objectives: Temporary, percutaneous peripheral nerve stimulation (PNS) has been shown to provide analgesia for acute postoperative pain, postamputation pain, and low back pain. The implanted device stimulates the neural target for up to 60 days at which point the leads are extracted. Patients have demonstrated prolonged analgesia continuing after extraction of the leads. The purpose of this case series is to demonstrate peripheral neural targets that could feasibly be used to treat various pain syndromes prevalent in the oncologic population.

Materials and methods: A temporary, percutaneous PNS was implanted under ultrasound guidance in 12 oncologic chronic pain patients seen in an outpatient pain clinic who had failed medical and/or interventional management. The device was implanted for up to 60 days. Clinical progress of pain and functional capacity was monitored through regular clinical visits.

Results: The case series presents seven successful cases of implementation of the PNS to treat oncologic pain. Three of these cases demonstrate targeting of proximal spinal nerves to treat truncal neuropathic pain and lumbar radicular pain. The four remaining cases demonstrate successful targeting of other peripheral nerves and brachial plexus. We also share five failed cases without adequate pain relief with PNS.

Conclusions: PNS has potential uses in the treatment of oncologic pain. Further high-quality studies should be designed to further elucidate use of the PNS to treat oncologic pain.

Keywords: Oncologic pain; peripheral nerve stimulator; post-herpetic neuralgia; post-mastectomy pain; post-thoracotomy pain.

© 2020 The Authors. Neuromodulation: Technology at the Neural Interface published by Wiley Periodicals LLC. on behalf of International Neuromodulation Society.

Figures

Figure 1
Figure 1
Image of the paravertebral approach to targeting the proximal T7 spinal nerve. Needle has traversed costotransverse ligament and is approaching spinal nerve (not seen). Arrow = needle tip, * = pleural space with small amount of pleural fluid, star = neuroforaminal space of T7.
Figure 2
Figure 2
Computed tomographic image of pelvis showing spindle cell sarcoma in right psoas. Mass was excised and radiated prior to placement of PNS. * = sarcoma.
Figure 3
Figure 3
Peripheral nerve stimulator leads shown targeting proximal L2 and L3 spinal nerves. Leads were placed under ultrasound guidance and confirmed under fluoroscopy. Arrows = PNS leads.
Figure 4
Figure 4
Ultrasound image of introducer demonstrating lead position for supraclavicular brachial plexus stimulation. * = tumor encasing brachial plexus, arrow = needle introducer tip.
Figure 5
Figure 5
Axial CT image at T1 level showing metastatic mass encasing brachial plexus. * = metastatic mass.

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