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Reg Anesth Pain Med. 2019 Jun;44(6):637-645. doi: 10.1136/rapm-2018-100109. Epub 2019 Apr 5.

Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: a multicenter, randomized, placebo-controlled trial.

Author information

1
Center for Clinical Research, Winston-Salem, North Carolina, USA cgilmore@ccrpain.com.
2
Anesthesiology, University of California, San Diego, La Jolla, California, USA.
3
Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA.
4
Premier Pain Centers, Shrewsbury, New Jersey, USA.
5
International Spine, Pain & Performance Center, Washington, District of Columbia, USA.
6
Ainsworth Institute of Pain Management, New York City, New York, USA.
7
Center for Clinical Research, Winston-Salem, North Carolina, USA.
8
Department of Anesthesiology, Northwestern University, Chicago, Illinois, USA.
9
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
10
SPR Therapeutics, Cleveland, Ohio, USA.

Abstract

BACKGROUND AND OBJECTIVES:

Chronic neuropathic pain is a common challenging condition following amputation. Recent research demonstrated the feasibility of percutaneously implanting fine-wire coiled peripheral nerve stimulation (PNS) leads in proximity to the sciatic and femoral nerves for postamputation pain. A multicenter, double-blinded, randomized, placebo-controlled study collected data on the safety and effectiveness of percutaneous PNS for chronic neuropathic pain following amputation.

METHODS:

Twenty-eight lower extremity amputees with postamputation pain were enrolled. Subjects underwent ultrasound-guided implantation of percutaneous PNS leads and were randomized to receive PNS or placebo for 4 weeks. The placebo group then crossed over and all subjects received PNS for four additional weeks. The primary efficacy endpoint evaluated the proportion of subjects reporting ≥50% pain reduction during weeks 1-4.

RESULTS:

A significantly greater proportion of subjects receiving PNS (n=7/12, 58%, p=0.037) demonstrated ≥50% reductions in average postamputation pain during weeks 1-4 compared with subjects receiving placebo (n=2/14, 14%). Two subjects were excluded from efficacy analysis due to eligibility changes. Significantly greater proportions of PNS subjects also reported ≥50% reductions in pain (n=8/12, 67%, p=0.014) and pain interference (n=8/10, 80%, p=0.003) after 8 weeks of therapy compared with subjects receiving placebo (pain: n=2/14, 14%; pain interference: n=2/13, 15%). Prospective follow-up is ongoing; four of five PNS subjects who have completed 12-month follow-up to date reported ≥50% pain relief.

CONCLUSIONS:

This work demonstrates that percutaneous PNS therapy may provide enduring clinically significant pain relief and improve disability in patients with chronic neuropathic postamputation pain.

TRIAL REGISTRATION NUMBER:

NCT01996254.

KEYWORDS:

neuropathic pain; peripheral nerve stimulation; phantom pain; post-amputation pain

PMID:
30954936
DOI:
10.1136/rapm-2018-100109

Conflict of interest statement

Competing interests: CG, JR, MD, RR, and LK have consulted for SPR Therapeutics. The institutions of CG, BI, SL, MD, JM, RR, and LK have received funding from SPR Therapeutics for other clinical studies. NC and JB are employees of SPR Therapeutics.

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