Peripheral Nerve Stimulation for the Treatment of Postamputation Pain: A Systematic Review.

ABSTRACT: Despite numerous first-line treatment interventions, adequately managing a patient's postamputation pain can be difficult. Peripheral nerve stimulation has emerged as a safe neuromodulatory intervention that can be used for many etiologies of chronic pain. We performed a systemic review to appraise the evidence of peripheral nerve stimulation use for improvement in postamputation pain. This was performed in Ovid, Cochrane databases, OVID, Scopus, Web of Science Core Collection, and PubMed. The primary outcome was improvement in postamputation pain after use of peripheral nerve stimulation. 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, 13 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 criteria, there is very low-quality Grading of Recommendations, Assessment, Development, and Evaluations evidence supporting that peripheral nerve stimulation is associated with improvements in pain intensity for postamputation pain. Future prospective, comparative, and well-powered studies assessing the use of peripheral nerve stimulation for postamputation pain are warranted.

Peripheral Nerve Stimulation for the Treatment of Phantom Limb Pain: A Case Series.

This case series aims to highlight the efficacy of peripheral nerve stimulation (PNS) in the treatment of phantom limb pain, as well as provide an alternative method for the treatment of this pain syndrome. In this report, we describe three amputee patients with severe phantom limb pain who obtained substantial analgesia and improvement in physical functionality after implantation of a temporary PNS device. Future studies should assess predictors of successful response or poor response to PNS therapy, such as mental health, environmental stressors, coping skills, and procedural factors. These factors may facilitate an individualized approach for each patient to ensure appropriate candidacy for PNS and better prognosis. Considering that patients in our cohort did not achieve long-lasting benefit after removal of temporary PNS, future research should assess if patients with phantom limb pain would benefit from permanent PNS, rather than temporary PNS.

Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review.

Dorsal root ganglion stimulation (DRG-S) is a form of selective neuromodulation therapy that targets the dorsal root ganglion. DRG-S offers analgesia in a variety of chronic pain conditions and is approved for treatment of complex regional pain syndrome (CRPS) by the US Food and Drug Administration (FDA). There has been increasing utilization of DRG-S to treat various neuropathic pain syndromes of the lower extremity, although evidence remains limited to one randomized controlled trial and 39 observational studies. In this review, we appraised the current evidence for DRG-S in the treatment of lower extremity neuropathic pain using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. The primary outcome was change in pain intensity after DRG-S compared to baseline. We stratified presentation of results based of type of neuropathy (CRPS, painful diabetic neuropathy, mononeuropathy, polyneuropathy) as well as location of neuropathy (hip, knee, foot). Future powered randomized controlled trials with homogeneous participants are warranted.