Retrospective Evaluation of Bipolar Peripheral Nerve Stimulation for Nociceptive and Neuropathic Pain: A Pilot Study

Abstract

Mansoor M Aman,1 Yussr M Ibrahim,2 Merve Buluk Figueira,1 Ahish Chitneni,3 Ammar Mahmoud2 1Department of Anesthesiology, Division of Pain Medicine, Advocate Health, Oshkosh, WI, USA; 2Department of Anesthesiology, Division of Pain Medicine, Northern Light Eastern Maine Medical Center, Bangor, ME, USA; 3Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USACorrespondence: Mansoor M Aman, Interventional Pain Medicine, Advocate Aurora Health, 700 N. Westhaven Drive, Oshkosh, WI, 54904, USA, Email [email protected]: This retrospective review evaluates pain and patient-defined functional goal improvement utilizing bipolar peripheral nerve stimulation (PNS) in chronic neuropathic and nociceptive pain states.Patients and Methods: Our dataset includes 24 patients who underwent implantation of a permanent peripheral nerve stimulator from January 2018 through December 2022. A total of 29 leads were implanted amongst 24 patients, with 5 patients having leads at 2 different dermatomes. Fifteen leads were placed for primarily neuropathic pain, and 14 leads were placed for nociceptive pain. Inclusion criteria were the following: pain duration greater than 6 months, documented peri-procedural Numerical Pain Rating Scale (NPRS) and greater than 60 days follow-up post implant.Results: Data was collected and analyzed showing that 89.6% of implants at 6 months follow-up and 70% at 12 months follow-up achieved 50% or greater pain relief. A significant reduction in NPRS scores when comparing pre-procedure pain scores (Median = 7, n = 29) to 6-month follow-up data (Median = 2, n = 29), p< 0.001 with a large effect size, r = 0.61. Ninety-three percent of patients reported achieving their personal functional goal. Twelve of the fourteen (86%) leads implanted for primary nociceptive pain and fourteen of the fifteen (93%) leads implanted for neuropathic pain achieved ≥ 50% relief at 6 months. At twelve months, seven leads in each group provided ≥ 50% sustained pain relief. Of the 14 patients that were on opioids, 6 discontinued, while another 2 had a reduction in oral morphine milligram equivalents (MME) at the 12-month follow-up.Conclusion: This retrospective review demonstrates the potential clinical application of PNS in both nociceptive and neuropathic pain states. Further prospective studies are warranted to validate the effectiveness of PNS in the treatment of refractory nociceptive and neuropathic pain states.Keywords: peripheral nerve stimulation, neuromodulation, neuropathic pain, nociceptive pain, chronic pain

Keywords

• peripheral nerve stimulation
• neuromodulation
• neuropathic pain
• nociceptive pain
• chronic pain