Peripheral Nerve Stimulation of Brachial Plexus Nerve Roots and Supra‐Scapular Nerve for Chronic Refractory Neuropathic Pain of the Upper Limb

摘要

Objectives We report the outcome of a consecutive series of 26 patients suffering from chronic medically‐refractory neuropathic pain of the upper limb (including 16 patients with complex regional pain syndrome), topographically limited, treated by brachial plexus (BP) nerve roots or supra‐scapular nerve (SSN) peripheral nerve stimulation (PNS). Materials and Methods The technique consisted in ultrasound‐guided percutaneous implantation of a cylindrical lead (Pisces‐Quad, Medtronic) close to the SSN or the cervical nerve roots within the BP, depending on the pain topography. All the patients underwent a positive trial stimulation before lead connection to a subcutaneous stimulator. Chronic bipolar stimulation mean parameters were: frequency 55.5 Hertz, voltage 1.17 Volts. The voltage was set below the threshold inducing muscle contractions or paresthesias. Results Two patients were lost immediately after surgery. At last follow‐up (mean 27.5 months), the 20 patients still using the stimulation experienced a mean pain relief of 67.1%. Seventeen patients were improved ≥50%, including 12 improved ≥70%. In 11 patients with a follow‐up 2 years, the mean pain relief was 68%. At last follow‐up, respectively, six out of the nine (67%) patients treated by SSN stimulation and 10 out of 17 patients (59%) treated by BP stimulation were improved ≥50%. At last follow‐up, 12 out of 20 patients still using the stimulation were very satisfied, six were satisfied, and two were poorly satisfied. Complications were: stimulation intolerance due to shock‐like sensations (three cases), superficial infection (1), lead fractures (2), and migration (1). Conclusion In this pilot study, SSN or BP roots PNS provided a relatively safe, durable and effective option to control upper limb neuropathic pain.