Peripheral nerve stimulation for the treatment of chronic pain

Abstract

The aim of this retrospective study is to evaluate the role of the implanted peripheral nerve stimulator in patients with pain in a peripheral nerve distribution. The current study is the largest in the literature that examines the role of the implantable peripheral nerve stimulator in the chronic pain patient. Our patient sample included 38 patients (with 41 nerve stimulators), consisting of 19 males and 19 females with a mean age of 44 years (SD = 11 years). Four groups of etiologic factors were identified; blunt or sharp nerve trauma (14/38), iatrogenic injuries from surgery (9/38), inadvertent injection of a nerve (9/38) and post surgery for entrapment or tumour (8/38). Stimulation was attempted in 45 patients, but an initial trial failed in 4. Mean follow-up time from implantation of the stimulator was 31 months (SD = 19 months). Compensation benefit was an issue in 29 cases (76%). Outcome following implantation was assessed based on pain criteria, narcotic usage and return to normal function/ work. Relief from preoperative pain was judged as good (>50% relief) by 23/38 patients (61%). A total of 15 patients reported fair or poor results (39%). Six patients required removal of their stimulators (15%) due to infection or reduction of pain control after an initial good result. A statistically significant decrease in reported pain level was found postoperatively ( p < 0.05). Workers’ compensation patients have equivalent outcomes to non-compensable patients ( p > 0.05). Eighteen of 38 (47%) patients reported a significant improvement in their activity levels following stimulator implant. In conclusion, over 60% of patients had a significant improvement in their pain and lifestyle following implantation of peripheral nerve stimulators. We therefore conclude that peripheral nerve stimulation can be useful in decreasing pain in well selected patients with severe pain in the distribution of a peripheral nerve.