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Review
. 2022 Oct 17;10(10):2606.
doi: 10.3390/biomedicines10102606.

Implantable Peripheral Nerve Stimulation for Peripheral Neuropathic Pain: A Systematic Review of Prospective Studies

Steven Char  1 , Max Y Jin  2 , Vinicius Tieppo Francio  3 , Nasir Hussain  4 , Eric J Wang  5 , Mahmoud Morsi  6 , Vwaire Orhurhu  7   8 , Larry J Prokop  9 , Adam Fink  10 , Ryan S D'Souza  11
Affiliations
Review

Implantable Peripheral Nerve Stimulation for Peripheral Neuropathic Pain: A Systematic Review of Prospective Studies

Steven Char et al. Biomedicines. .

Abstract

Peripheral nerve stimulation (PNS) has been utilized for over 50 years with accumulating evidence of efficacy in a variety of chronic pain conditions. The level and strength of evidence supporting the use of PNS for peripheral neuropathic pain remains unclear. The purpose of this review is to synthesize data from prospective studies on the efficacy of PNS for neuropathic pain as it pertains to pain intensity, neurological deficits/neuropathy (e.g., weakness, sensory deficits, gait/balance), and other secondary outcomes (quality of life, satisfaction, emotional functioning, and adverse events). In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, this review identified articles from MEDLINE(R), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Overall, per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, pooled results demonstrate very low quality or low quality of evidence supporting modest to substantial improvement in pain and neurological function after PNS implantation for treatment of peripheral neuropathic pain. PNS for phantom limb pain was the only indication that had moderate level evidence. Future prospective and well-powered studies are warranted to assess the efficacy of PNS for peripheral neuropathic pain.

Keywords: chronic pain; neuromodulation; peripheral nerve stimulator; peripheral neuropathy.

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Conflict of interest statement

Dr. Ryan S. D’Souza has an investigator-initiated grant with Nevro Corp and Saol Therapeutics. Dr. Vinicius Tieppo Francio has an investigator-initiated grant with Nevro Corp. Other authors have no conflict of interest related to this work. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA Flow Chart. PRISMA flow diagram for systematic review. Flowchart of the study selection process, inclusion and exclusion of studies, and reasons for exclusion are displayed.
Figure 2
Figure 2
Cochrane Risk-of-Bias Assessment of prospective trials.
See this image and copyright information in PMC

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