Peripheral Nerve Stimulation in Painful Conditions of the Upper Extremity—An Overview

Abstract

Our objective is to present a brief history of the evolution of peripheral nerve stimulation, the current understanding of peripheral nerve stimulation mechanisms in chronic pain, peripheral nerve stimulation applications in upper extremity chronic pain conditions, and complications of peripheral nerve stimulation. The evolution of peripheral nerve stimulation from the early ages to the current status has been facilitated by discoveries in neurobehavioral mechanisms of pain, advances in technology and percutaneous lead development, and the availability of high-quality portable ultrasound units. Peripheral nerve stimulation application in managing upper extremity pain of amputated limbs, post-stroke shoulder pain, complex regional pain syndrome (CRPS), and median, ulnar, and radial neuropathies are discussed. Finally, we describe complications of peripheral nerve stimulation. The availability of ultrasound-guided peripheral nerve stimulation techniques and superior peripheral nerve stimulation technology have opened up new and minimally invasive treatment options for chronic intractable neuropathic pain of the upper extremity. Additionally, the ability to place peripheral nerve stimulation leads percutaneously without open peripheral nerve surgery expands the pool of implanting physicians, while simultaneously decreasing the risks and complications that are associated with open surgery.

The Relevance of Implanted Percutaneous Electrical Nerve Stimulation in Orthopedics Surgery: A Systematic Review

“…Implants were placed between 8 and 97 days from the original surgery. Patients reported significant reductions in pain levels during periods of rest, with an average decrease of 93% and 63% [13,14]. Similarly, pain reductions were noted during both active (average of 30% and 50%) and passive ranges of motion (average of 27% and 14%) [24,25].…”

“…PNS boasts a diverse range of applications, addressing nerves implicated in conditions such as paralysis, epilepsy, depression, urinary and gastrointestinal disorders, headaches, and chronic pain syndromes related to amputation, post stroke shoulder pain, complex regional pain syndrome and neuropathies [1,14]. Recently, PNS has gained popularity in orthopedic surgery as several feasibility studies and proof-of-concept case reports and case series have supported its use as a pain control device in patients suffering from pain due to orthopedic pathologies involving the knee, shoulder, and foot [15][16][17].…”

Permanent Peripheral Nerve Stimulator for Complex Regional Pain Syndrome of the Forearm and Hand

“…Peripheral nerve stimulation can be used to treat refractory neuropathic pain through focused delivery of electrical impulses to a single nerve proximal to the site of pain. 3,4 According to the Gate-Control hypothesis, PNS inhibits ascending noxious impulses from nociceptors through nonpainful stimulation of large diameter sensory fibers. Other physiologic mechanisms, such as collision of ortho- and antidromic activity in Aβ nerve fibers, may also contribute to PNS efficacy.…”