Disclosures: NDI Medical (the sponsor of this study) and SPR Therapeutics (a subsidiary of NDI Medical) have a commercial interest in the device presented in this case report. Richard Rauck, MD, Leonardo Kapural, MD, PhD, and Steven P. Cohen, MD are consultants to NDI Medical. Rosemary Zang, RN is an employee of SPR Therapeutics, and Joseph Boggs, PhD is an employee of NDI Medical.
Peripheral Nerve Stimulation for the Treatment of Postamputation Pain—A Case Report
Version of Record online: 2 MAY 2012
© 2012 The Authors. Pain Practice © 2012 World Institute of Pain
Volume 12, Issue 8, pages 649–655, November 2012
How to Cite
Rauck, R. L., Kapural, L., Cohen, S. P., North, J. M., Gilmore, C. A., Zang, R. H. and Boggs, J. W. (2012), Peripheral Nerve Stimulation for the Treatment of Postamputation Pain—A Case Report. Pain Practice, 12: 649–655. doi: 10.1111/j.1533-2500.2012.00552.x
Device status: An investigational percutaneous peripheral nerve stimulator system (NDI Medical) including a percutaneous intramuscular lead and commercially available external stimulators (Maxima® II and Rehabilicare® NT2000, Empi, Inc, St. Paul, MN) was used during this clinical study. The peripheral nerve stimulation systems were provided by NDI Medical.
- Issue online: 5 NOV 2012
- Version of Record online: 2 MAY 2012
- Submitted: September 19, 2011; Revision accepted: February 29, 2012
- phantom limb pain;
- residual limb pain;
- electrical stimulation;
- peripheral nerve stimulation
Many amputees suffer from postamputation pain, which can be extremely debilitating, decrease quality of life, increase the risk of depression, and negatively affect interpersonal relationships and the ability to work. Present methods of treatment, including medications, are often unsatisfactory in reducing postamputation pain. Electrical stimulation of the nerve innervating the painful area could reduce the pain, but peripheral nerve stimulation is rarely used to treat postamputation pain because present methods require invasive surgical access and precise placement of the leads in close proximity (≤ 2 mm) with the nerve. The present study investigated a novel approach to peripheral nerve stimulation in which a lead was placed percutaneously a remote distance (> 1 cm) away from the femoral nerve in a patient with severe residual limb pain (RLP) 33 years following a below-knee amputation. Electrical stimulation generated ≥ 75% paresthesia coverage, reduced RLP by > 60%, and improved quality of life outcomes as measured by the pain interference scale of the Brief Pain Inventory-Short Form (100% reduction in pain interference), Pain Disability Index (74% reduction in disability), and the Patient Global Impression of Change (very much improved) during a 2-week home trial. There were no adverse events. The ability to generate significant paresthesia coverage and pain relief with a single lead inserted percutaneously and remotely from the target nerve holds promise for providing relief of postamputation pain.