Peripheral nErve Stimulation for the Management of Acute and Subacute Post-Amputation Pain: A Randomized, Controlled Feasibility Trial

Abstract

Introduction & aim: Temporary (60-day) percutaneous peripheral nerve stimulation (PNS) has demonstrated effectiveness for the treatment of chronic post-amputation pain, and this pilot study aims to evaluate the feasibility of temporary percutaneous PNS for the treatment of acute post-amputation pain. Patients & methods: Sixteen veterans undergoing lower extremity amputation received PNS and standard medical therapy or standard medical therapy alone. Results: The PNS group reported greater reductions in average phantom limb pain, residual limb pain and daily opioid consumption, and there were fewer participants taking opioids through 3 months post-amputation. Conclusion: This pilot study suggests that PNS is feasible in the acute postoperative period following lower limb amputation and may provide a non-pharmacologic analgesic therapy that lowers pain scores and reduces opioid consumption, and thus warrants further investigation.

Peripheral Nerve Stimulation for the Treatment of Phantom Limb Pain: A Case Series

“…Our results are concordant with the literature, which highlights efcacy of PNS in treatment of post-amputation pain [4,5,10]. Our data are also consistent with superior analgesia and clinical outcomes from PNS treatment of both acute and chronic pain syndromes in the back, upper extremity, lower extremity, and head [4,11].…”

“…Potential explanations for this include comorbid psychiatric and medical comorbidities in all three patients, which may have amplifed their pain intensity and afected their response to PNS. Moreover, prior literature on PNS for postamputation pain excluded certain patients, such as those with diabetes, bleeding disorders, autoimmune disorders, and depression, which may explain the diferences in outcomes between our case series and the results of prior studies [4,5]. Interestingly, patient #3 in this series had a history of erythromelalgia, which may be an additional factor leading to treatment-resistant and refractory pain, given its interplay with the peripheral vasculature and peripheral nervous system.…”

“…Additional clinical studies are needed to further assess the efcacy of PNS in the treatment of phantom limb pain. Te current literature suggests that PNS therapy may provide clinically signifcant pain relief and improvement in the quality of life of patients with chronic neuropathic postamputation pain, which usually includes both residual limb pain and phantom limb pain [4,5,10,12].…”

“…Despite these measures, many patients with PLP fail to achieve adequate analgesia [3], which has resulted in growing interest in the use of neuromodulation to address this pain. Specifcally, peripheral nerve stimulation (PNS) has recently emerged as a neuromodulation intervention that can be utilized to treat refractory manifestations of chronic pain, including postamputation pain [4,5]. Tis case series aims to highlight the efcacy of PNS in three patients with phantom limb pain from a single tertiary academic center as well as propose a treatment algorithm for phantom limb pain that incorporates the use of PNS.…”

The morphological and morphometric study of the sciatic nerve after amputation and prosthetics of the leg experimentally using an original implant

“…Механизмы ее формирования остаются до конца не изученными [8,13], и до настоящего времени непонятно, почему одни пациенты страдают от боли, а другие нет [14]. Вклад периферических нервов в патогенез болевого синдрома после ампутации нижней конечности остается недооцененным [8,13], хотя имеются данные, что их чрескожная стимуляция эффективна при лечении хронической боли после ампутации [15,16].…”