Fully Implantable Peripheral Nerve Stimulation for the Treatment of Hemiplegic Shoulder Pain

Abstract

This case report describes the first participant treated with a fully-implantable, single-lead peripheral nerve stimulation (PNS) system for refractory hemiplegic shoulder pain (HSP). During the 6-wk trial-stage, a temporary lead was placed percutaneously near the terminal branches of the axillary nerve to the deltoid. The primary outcome measure was the Brief Pain Inventory-Short Form Question 3 (BPI-3), a 0–10 pain numeric rating scale. The participant experienced 75% pain reduction and proceeded to the implant-stage where he received a single-lead, implantable pulse generator. After 3-wks, the participant became pain-free. However, 7-wks after implantation, the system was turned off due to an unrelated acute medical illness. HSP reemerged with BPI-3 of 9. After 11-wks of recovery, PNS was reinitiated and the participant became pain-free through the 9-months follow-up. At 12-months, BPI-3 was a 1. This case report demonstrates the feasibility of a single-lead, fully-implantable PNS system for refractory HSP.

Demystifying Poststroke Pain: From Etiology to Treatment

“…A 2014 randomized controlled trial of 25 patients in which the experimental group received 3 weeks of peripheral nerve stimulation showed sustained significant pain relief up to 12 weeks after therapy [100]. In addition, a recent case report in a patient with hemiplegic shoulder pain who received a fully implantable peripheral nerve stimulator showed efficacy at the 12‐month mark, demonstrating the long‐term effectiveness of this technology and avoiding the necessity of frequent outpatient visits to receive therapy [101].…”

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

“…8 In brief, the IPG was placed under local anesthesia and conscious sedation or general anesthesia, at the discretion of the surgeon. Placement of the implantable lead 10 was determined after placement of monopolar needle electrodes at the location to stimulate the axillary nerve motor points of the middle and posterior deltoids.…”

“…The procedure for implanting the IPG has been described previously . In brief, the IPG was placed under local anesthesia and conscious sedation or general anesthesia, at the discretion of the surgeon.…”

“…A fully implantable PNS system was developed and a case study reported successful pain relief for at least 12 months. 8 …”

“…These patients may benefit from a permanently placed system for long‐term treatment. A fully implantable PNS system was developed and a case study reported successful pain relief for at least 12 months .…”