Subthreshold Peripheral Nerve Stimulation with a High Frequency Electric Magnetic Coupled (HF-EMC) Powered Implanted Receiver: A Case Series

Abstract

BACKGROUND: Peripheral nerve stimulation (PNS) is an effective alternative for the management of neuropathic peripheral chronic pain, but the high incidence of adverse events such as lead and battery erosion, migration, lead fracture, disconnection, and infection have limited the widespread use of PNS. Neuromodulation technology that does not include implantable pulse generators (IPGs) but a 4- or 8-contact electrode array with embedded electronics and a small, externally worn rechargeable transmitter reduces the complications related to the implant of an IPG. PNS has traditionally been performed with a tonic stimulation protocol. This case series describes a wireless PNS device at subthreshold frequencies for the treatment of neuropathic pain of peripheral nerve origins. CASE REPORT: No adverse events were reported, and no complications were encountered during implantation. All patients reported more than 50% pain relief during the one-week trial period, sustained pain relief with various placements and number of electrodes, and an important improvement in quality of life and sleep. Mean VAS scores decreased 78% at one month (n = 11) and remained stable at 6 months with 91% reduction (n = 5) and 76% reduction (n = 1) at 12 months. Mean PGIC at 6 months was 7 of 7. CONCLUSION: Percutaneous placement of an externally powered neurostimulation device adjacent to the affected peripheral nerve(s) is an effective, minimally invasive, and reversible method of pain control in patients with neuropathic pain. PNS using subthreshold frequencies effectively controls neuropathic pain from multiple peripheral nerve targets. KEY WORDS: High frequency, peripheral nerve stimulation, peripheral neuropathic pain, externally powered