Peripheral Nerve Stimulation for Treatment of Post-Amputation Pain – A Case Report

• Published in: Pain practice Vol. 12; no. 8; pp. 649 - 655
• Main Authors: Rauck, Richard L., Kapural, Leonardo, Cohen, Steven P., North, James M., Gilmore, Christopher A., Zang, Rosemary H., Boggs, Joseph W.
• Format: Journal Article
• Language: English
• Published: 02.05.2012
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/j.1533-2500.2012.00552.x

Many amputees suffer from post-amputation 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 post-amputation pain. Electrical stimulation of the nerve innervating the painful area could reduce the pain, but peripheral nerve stimulation is rarely used to treat post-amputation 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 33 years following a below-knee amputation. Electrical stimulation generated ≥ 75% paresthesia coverage, reduced residual limb pain 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 post-amputation pain.