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

Steven P Cohen, Christopher A Gilmore, Richard L Rauck, Denise D Lester, Robert J Trainer, Thomas Phan, Leonardo Kapural, James M North, Nathan D Crosby, Joseph W Boggs, Steven P Cohen, Christopher A Gilmore, Richard L Rauck, Denise D Lester, Robert J Trainer, Thomas Phan, Leonardo Kapural, James M North, Nathan D Crosby, Joseph W Boggs

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.

Keywords: amputation; peripheral nerve stimulation; phantom pain; post-amputation pain.

© Oxford University Press OR Association of Military Surgeons of the United States 2019.

Figures

FIGURE 1.
FIGURE 1.
(A) The percutaneous PNS therapy uses fine-wire, coiled leads typically implanted under ultrasound guidance. (B) Ultrasound image showing the implantation of a lead approximately 0.5–1 cm remote from the femoral nerve for the treatment of chronic pain in a lower extremity amputee.
FIGURE 2.
FIGURE 2.
(A) Reductions of ≥50% in average post-amputation pain were reported in 18/24 subjects (75%), (B) reductions of ≥50% in average pain interference were reported in 17/21 subjects (81%), and (C) Beck Depression Inventory II (BDI-II) scores were reduced from baseline in 13/21 subjects (62%) at the end of up to 60 days of percutaneous PNS therapy (EOT) in recent studies and clinical reports.,,

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