Combined Use of Peripheral Nerve Surgery and Peripheral Nerve Stimulation in Patients With Refractory Neuropathic Pain

Introduction

Peripheral nerve injury (PNI) can lead to chronic neuropathic pain, significantly impacting quality of life. While surgical intervention may offer relief in some cases, outcomes are variable. Peripheral nerve stimulation (PNS) offers an alternative treatment approach for managing neuropathic pain in these patients. This study aims to describe the outcomes of a combined surgical and PNS approach for severe, refractory neuropathic pain following PNI or amputation.

Methods

A cross-sectional survey was conducted on seven patients who underwent combined peripheral nerve surgery and PNS at a specialized multidisciplinary nerve clinic. Patient-reported outcome measures, including pain scores, Patient's Global Impression of Change (PGIC), and quality of life metrics, were collected. Patient data were retrospectively reviewed.

Results

The cohort included five males and two females (mean age 58.3 ± 8.9 years), with four amputees and three non-amputees. The average follow-up duration was 2.4 ± 0.8 years. Six out of seven patients reported reduced pain when the stimulator was activated, with an average pain score reduction of 4.4 ± 1.5 points. All seven patients reported improvement on the PGIC scale. Mean pain intensity and pain interference scores averaged 54.7 ± 5.5 and 66.3 ± 6.5, respectively. One patient underwent device removal due to irritation from the topical adhesive.

Conclusion

This proof-of-concept study suggests that combined peripheral nerve surgery and PNS may be a viable option for carefully selected patients with severe, refractory neuropathic pain. While pain reduction and functional improvement were observed in most patients, outcomes varied considerably. Future prospective studies with larger cohorts are needed to refine patient selection criteria and optimize this combined approach.