ABSTRACT
Introduction & aim: Temporary (60-day) percutaneous peripheral nerve stimulation (PNS) has demonstrated effectiveness for the treatment of chronic post-amputation pain, and this pilot study aims to evaluate the feasibility of temporary percutaneous PNS for the treatment of acute post-amputation pain. Patients & methods: Sixteen veterans undergoing lower extremity amputation received PNS and standard medical therapy or standard medical therapy alone. Results: The PNS group reported greater reductions in average phantom limb pain, residual limb pain and daily opioid consumption, and there were fewer participants taking opioids through 3 months post-amputation. Conclusion: This pilot study suggests that PNS is feasible in the acute postoperative period following lower limb amputation and may provide a non-pharmacologic analgesic therapy that lowers pain scores and reduces opioid consumption, and thus warrants further investigation.
A small study was done to evaluate placing a wire lead near a nerve to electrically stimulate it for 60 days after a leg amputation surgery to see if it helps reduce pain. The study looked at 16 veterans who had an amputation to their leg. These patients were divided into either a group that received nerve stimulation plus normal pain control medications or a group that just received pain medications. The group that received nerve stimulation had less pain in the remaining leg and less phantom pain (pain in the missing leg). They also required fewer narcotic medications. The study suggested that nerve stimulation may provide an effective way to manage pain after amputation and reduce the use of pain medications. Clinical Trial Registration Number: NCT03484429.
Subject(s)
Pain, Postoperative , Phantom Limb , Amputation, Surgical/adverse effects , Feasibility Studies , Humans , Pain Measurement , Pain, Postoperative/etiology , Pain, Postoperative/therapy , Peripheral Nerves , Phantom Limb/therapy , Pilot ProjectsABSTRACT
INTRODUCTION: Chronic pain and reduced function are significant problems for Military Service members and Veterans following amputation. Peripheral nerve stimulation (PNS) is a promising therapy, but PNS systems have traditionally been limited by invasiveness and complications. Recently, a novel percutaneous PNS system was developed to reduce the risk of complications and enable delivery of stimulation without surgery. MATERIALS AND METHODS: Percutaneous PNS was evaluated to determine if stimulation provides relief from residual and phantom limb pain following lower-extremity amputation. PNS leads were implanted percutaneously to deliver stimulation to the femoral and/or sciatic nerves. Patients received stimulation for up to 60 days followed by withdrawal of the leads. RESULTS: A review of recent studies and clinical reports found that a majority of patients (18/24, 75%) reported substantial (≥50%) clinically relevant relief of chronic post-amputation pain following up to 60 days of percutaneous PNS. Reductions in pain were frequently associated with reductions in disability and pain interference. CONCLUSIONS: Percutaneous PNS can durably reduce pain, thereby enabling improvements in quality of life, function, and rehabilitation in individuals with residual or phantom limb pain following amputation. Percutaneous PNS may have additional benefit for Military Service members and Veterans with post-surgical or post-traumatic pain.
Subject(s)
Amputation, Surgical/adverse effects , Chronic Pain/therapy , Transcutaneous Electric Nerve Stimulation/methods , Adult , Amputation, Surgical/psychology , Chronic Pain/psychology , Female , Humans , Male , Middle Aged , Pain Management/methods , Pain Management/standards , Pain Management/statistics & numerical data , Pain Measurement/methods , Phantom Limb/psychology , Phantom Limb/therapy , Transcutaneous Electric Nerve Stimulation/standards , Transcutaneous Electric Nerve Stimulation/statistics & numerical data , Treatment OutcomeABSTRACT
Intestinal perfusion with carbohydrates inhibits gastric emptying via vagal and spinal capsaicin-sensitive afferent pathways. The aim of the present study was to determine the role of 1) 5-hydroxytryptamine (5-HT)(3) receptors (5-HT(3)R) in mediating glucose-induced inhibition of gastric emptying and 2) 5-HT(3)R expression in vagal and spinal afferents in innervating the duodenum. In awake rats fitted with gastric and duodenal cannulas, perfusion of the duodenum with glucose (50 and 100 mg) inhibited gastric emptying. Intestinal perfusion of mannitol inhibited gastric emptying only at the highest concentration (990 mosm/kgH(2)O). Pretreatment with the 5-HT(3)R antagonist tropisetron abolished both glucose- and mannitol-induced inhibition of gastric emptying. Retrograde labeling of visceral afferents by injection of dextran-conjugated Texas Red into the duodenal wall was used to identify extrinsic primary afferents. Immunoreactivity for 5-HT(3)R, visualized with an antibody directed to the COOH terminus of the rat 5-HT(3)R, was found in >80% of duodenal vagal and spinal afferents. These results show that duodenal extrinsic afferents express 5-HT(3)R and that the receptor mediates specific glucose-induced inhibition of gastric emptying. These findings support the hypothesis that enterochromaffin cells in the intestinal mucosa release 5-HT in response to glucose, which activates 5-HT(3)R on afferent nerve terminals to evoke reflex changes in gastric motility. The primary glucose sensors of the intestine may be mucosal enterochromaffin cells.