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

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 e...

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Autores principales: Gilmore, Christopher A., Kapural, Leonardo, McGee, Meredith J., Boggs, Joseph W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079182/
https://www.ncbi.nlm.nih.gov/pubmed/31693791
http://dx.doi.org/10.1111/papr.12856
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author Gilmore, Christopher A.
Kapural, Leonardo
McGee, Meredith J.
Boggs, Joseph W.
author_facet Gilmore, Christopher A.
Kapural, Leonardo
McGee, Meredith J.
Boggs, Joseph W.
author_sort Gilmore, Christopher A.
collection PubMed
description 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.
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spelling pubmed-70791822020-03-19 Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant Gilmore, Christopher A. Kapural, Leonardo McGee, Meredith J. Boggs, Joseph W. Pain Pract Original Articles 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. John Wiley and Sons Inc. 2019-12-02 2020-03 /pmc/articles/PMC7079182/ /pubmed/31693791 http://dx.doi.org/10.1111/papr.12856 Text en © 2019 The Authors. Pain Practice published by Wiley Periodicals, Inc. on behalf of World Institute of Pain This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Gilmore, Christopher A.
Kapural, Leonardo
McGee, Meredith J.
Boggs, Joseph W.
Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant
title Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant
title_full Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant
title_fullStr Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant
title_full_unstemmed Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant
title_short Percutaneous Peripheral Nerve Stimulation for Chronic Low Back Pain: Prospective Case Series With 1 Year of Sustained Relief Following Short‐Term Implant
title_sort percutaneous peripheral nerve stimulation for chronic low back pain: prospective case series with 1 year of sustained relief following short‐term implant
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079182/
https://www.ncbi.nlm.nih.gov/pubmed/31693791
http://dx.doi.org/10.1111/papr.12856
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