Implantable Peripheral Nerve Stimulation for Peripheral Neuropathic Pain: A Systematic Review of Prospective Studies

Abstract

Peripheral nerve stimulation (PNS) has been utilized for over 50 years with accumulating evidence of efficacy in a variety of chronic pain conditions. The level and strength of evidence supporting the use of PNS for peripheral neuropathic pain remains unclear. The purpose of this review is to synthesize data from prospective studies on the efficacy of PNS for neuropathic pain as it pertains to pain intensity, neurological deficits/neuropathy (e.g., weakness, sensory deficits, gait/balance), and other secondary outcomes (quality of life, satisfaction, emotional functioning, and adverse events). In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, this review identified articles from MEDLINE(R), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Overall, per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, pooled results demonstrate very low quality or low quality of evidence supporting modest to substantial improvement in pain and neurological function after PNS implantation for treatment of peripheral neuropathic pain. PNS for phantom limb pain was the only indication that had moderate level evidence. Future prospective and well-powered studies are warranted to assess the efficacy of PNS for peripheral neuropathic pain.

Wireless Battery-free and Fully Implantable Organ Interfaces

“…These devices are primarily used for the treatment for conditions, including chronic pain, movement disorders, and neurological disorders. As per current status, the efficacy and patient adherence to these devices is low: not all patients who receive neurostimulation therapy continue using the devices long-term . Factors such as the specific condition being treated, individual response to therapy, and patient preferences can influence device utilization and patient satisfaction, highlighting the need for innovation in imperceptible and chronically stable solutions.…”

Pain in the Context of Sensory Deafferentation

“…A systematic review assessing peripheral nerve stimulation for neuropathic pain reported moderate evidence only for lower extremity phantom limb pain, which was based on one placebo-controlled and several uncontrolled industry-sponsored studies. 148 In the placebo-controlled trial, 58% of the treatment group who underwent femoral and sciatic nerve peripheral nerve stimulation experienced 50% or greater relief of postamputation pain (comparable benefit for residual limb and phantom limb pain) versus 14% of control patients. At 12 months, 67% of the treatment group reported sustained benefit.…”

Methodological and statistical characteristics of meta-analyses on spinal cord stimulation for chronic pain: a systematic review

“…These findings are concerning because MAs are often used to guide clinical decisions and direct practice guidelines because they are considered to be the highest level of evidence. 7 Furthermore, given that the quality of evidence from many trials in the neuromodulation literature is already considered low [39][40][41][42][43][44] pooling low-quality trials within low-quality MA likely further compounds poor-quality evidence and compromises accurate data representation.…”