High-frequency peripheral electric nerve block to treat postamputation pain

Abstract

Postamputation residual limb pain is often a disabling chronic pain condition. Oftentimes, patients are left with a chronic stump pain that is refractory to current pain management modalities, such as medications, peripheral nerve blocks or denervation techniques, nerve or spinal cord stimulation, or surgical revision. Using high-frequency alternating current via a peripheral nerve cuff electrode creates a complete depolarizing nerve block, which blocks painful or unwanted nerve transmission of pain signals; the cuff is placed proximal to the neuroma at the end of the severed nerve. This article demonstrates the technique of placing a peripheral nerve cuff surgically around the peripheral nerves of patients who suffer from debilitating stump pain with lower extremity amputations. In total, 10 patients were implanted with the nerve cuff with 9 patients receiving in-clinic testing and 7 patients progressing onto long-term home-use. The average numerical rating scale pain scale for tested patients decreased from 5.7-1.4 (out of 10) after high-frequency alternating current electrical nerve block therapy with 85% of all testing sessions yielding a >50% pain reduction. Additionally, patients noted improved ability to maintain activity of daily living, as well as noted improvement of quality of life scores, and a reduction in overall pain medication use. Although the study’s initial endpoint was 90 days, we have continued to follow our implanted patients who have now reached 36 months.