Peripheral Nerve Stimulation for Treatment of Severe Refractory Upper Extremity Post-Amputation Pain

Abstract

Severe pain is a significant and potentially debilitating consequence of amputation and may be highly challenging to treat ( 1. Hsu E Cohen SP Postamputation pain: epidemiology, mechanisms, and treatment. J Pain Res. 2013; 6: 121-136 PubMed Google Scholar ). Amputees frequently have a combination of phantom limb pain (PLP) and residual limb pain (RLP). Peripheral nerve stimulation (PNS) is an advantageous form of neuromodulation that provides more selective stimulation and analgesia, as well as less procedural invasiveness, compared to traditional spinal cord stimulation (SCS). With the introduction of novel, commercially available, percutaneous systems, PNS is re-emerging as a useful therapy for neuropathic pain ( 2. Rauck RL Cohen SP Gilmore CA et al. Treatment of post-amputation pain with peripheral nerve stimulation. Neuromodulation. 2014; 17: 188-197 Abstract Full Text Full Text PDF PubMed Google Scholar , 3. Cohen SP Gilmore CA Rauck RL et al. Percutaneous peripheral nerve stimulation for the treatment of chronic pain following amputation. Mil Med. 2019; 184: e267-e274 Crossref PubMed Scopus (15) Google Scholar ). This modality utilizes electrodes adjacent to peripheral nerves to treat painful conditions such as peripheral neuropathic pain and complex regional pain syndrome (CRPS) ( 4. Petersen BA Nanivadekar AC Chandrasekaran S Fisher LE Phantom limb pain: peripheral neuromodulatory and neuroprosthetic approaches to treatment. Muscle Nerve. 2019; 59: 154-167 Crossref PubMed Scopus (6) Google Scholar ). Recent research including a multicenter, randomized, controlled trial (RCT) has shown the effectiveness of PNS for lower extremity post-amputation pain ( 2. Rauck RL Cohen SP Gilmore CA et al. Treatment of post-amputation pain with peripheral nerve stimulation. Neuromodulation. 2014; 17: 188-197 Abstract Full Text Full Text PDF PubMed Google Scholar , 3. Cohen SP Gilmore CA Rauck RL et al. Percutaneous peripheral nerve stimulation for the treatment of chronic pain following amputation. Mil Med. 2019; 184: e267-e274 Crossref PubMed Scopus (15) Google Scholar , 5. Gilmore CA, Ilfeld BM, Rosenow JM et al. Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2019;rapm-2019-100937. https://pubmed.ncbi.nlm.nih.gov/31740443/. Google Scholar ). These studies have shown improvement in both PLP and RLP, which makes this modality attractive for use with amputees. Notably, all studies to date have been limited exclusively to the lower extremity. Thus, we present a case description of PNS used for treatment of severe refractory upper extremity post-amputation pain.