Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant

• Published in: Pain practice Vol. 20; no. 3; pp. 310 - 320
• Main Authors: Gilmore, Christopher A., Kapural, Leonardo, McGee, Meredith J., Boggs, Joseph W.
• Format: Journal Article
• Language: English
• Published: United States John Wiley and Sons Inc 01.03.2020
• Subjects: Adult; chronic pain; disability; Female; Humans; low back pain; Low Back Pain - therapy; Male; Middle Aged; Neurosurgical Procedures; Original; Pain Management - methods; percutaneous peripheral nerve stimulation; Prospective Studies; Transcutaneous Electric Nerve Stimulation - methods; Treatment Outcome; chronic pain; percutaneous peripheral nerve stimulation; disability; low back pain
• ISSN: 1530-7085; 1533-2500; 1533-2500
• DOI: 10.1111/papr.12856

Introduction Percutaneous peripheral nerve stimulation (PNS) provides an opportunity to relieve chronic low back pain and reduce opioid analgesic consumption as an alternative to radiofrequency ablation and permanently implanted neurostimulation systems. Traditionally, the use of neurostimulation earlier in the treatment continuum has been limited by its associated risk, invasiveness, and cost. Methods Percutaneous PNS leads (SPRINT MicroLead) were placed bilaterally to target the medial branches of the dorsal rami nerves under image guidance. The percutaneous leads were connected to miniature wearable stimulators (SPRINT PNS System) for the 1‐month therapy period, after which the leads were removed. Pain and disability were assessed long‐term up to 12 months after lead removal. Results Substantial, clinically significant reductions in average pain intensity (≥50% reduction as measured by the Brief Pain Inventory Short Form) were experienced by a majority of subjects (67%) at end of treatment compared to baseline (average 80% reduction among responders; P < 0.05, analysis of variance; n = 9). Twelve months after the end of PNS treatment, a majority of subjects who completed the long‐term follow‐up visits experienced sustained, clinically significant reductions in pain and/or disability (67%, n = 6; average 63% reduction in pain intensity and 32‐point reduction in disability among responders). No serious or unanticipated adverse events were reported. Conclusions This study challenges the long‐held notion that a positive trial of PNS should be followed by a permanent implant in responders. Percutaneous PNS may serve as an effective neurostimulation therapy for patients with chronic low back pain and should be considered earlier in the treatment continuum as a motor‐sparing means of avoiding opioids, denervation, and permanently implanted neurostimulation systems.