Peripheral Nerve Stimulation for the Treatment of Post-Amputation Pain: A Systematic Review.

Abstract

Despite numerous first-line treatment interventions, adequately managing a patient's post-amputation pain (PAP) can be difficult. Peripheral nerve stimulation (PNS) has emerged as a safe neuromodulatory intervention that can be utilized for many etiologies of chronic pain. We performed a systemic review to appraise the evidence of PNS use for improvement in PAP. This was performed in Ovid, Cochrane databases, OVID, Scopus, Web of Science Core Collection, and PubMed. The primary outcome was improvement in PAP after use of PNS. Secondary outcomes included improvements in functional status, opioid usage, and mood. Data extraction and risk of bias assessments were performed independently in a blinded manner. Of the 989 studies identified, thirteen studies were included consisting of three randomized control trials, seven observational studies, and three case series. While large heterogeneity limited definitive conclusions, the included studies generally demonstrated favorable outcomes regarding pain reduction. Each included study that used an objective pain scale demonstrated clinically significant pain improvements. Per the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria, there is very low-quality GRADE evidence supporting that PNS is associated with improvements in pain intensity for PAP. Future prospective, comparative, and well-powered studies assessing the use of PNS for PAP are warranted.