Use of spinal cord stimulation for the treatment of post total knee arthroplasty pain

Urits, Ivan; Markel, Michael; Vij, Neeraj; Ulanday, Josh; Machek, Megan; An, Daniel; Charipova, Karina; Gress, Kyle; Herman, Jared; Kaye, Alan D.; Viswanath, Omar

doi:10.1016/j.bpa.2020.07.006

Cited by 3 publications

(5 citation statements)

References 30 publications

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“…The results according pain relief are comparable to DRGS and Spinal cord systems 1 , 8 , 23 . Martin et al 11 show a significant improvement of pain in 12 of 14 patients (85%) and a mean reduction in daily morphine dosage of 54% with a mean follow-up time of 24 months using DRG stimulation.…”

Section: Discussionsupporting

confidence: 63%

“…The average age of our population is increasing, resulting in a high incidence of chronic degenerative knee pathologies. Total knee replacement surgery (TKA) is a frequently performed elective procedure indicated for subjects with knee pain, refractory to conservative therapies 1 . In the United States alone, about 600,000 total knee arthroplasties are performed annually, with a significant increase projected by 2030 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore revision surgeries have limited success rates when performed solely for pain 9 . Due to the increasing concern for the overuse/abuse of opioid medication, there is a strong need for suitable and effective treatment alternatives 1 .…”

Section: Introductionmentioning

confidence: 99%

“…Neuromodulation techniques like spinal cord stimulation (SCS) and/or dorsal root ganglion stimulation (DRGS) have been successfully used in the treatment of chronic knee pain 1 , 4 , 8 , 10 , 11 . The evidence involving peripheral nerve stimulation (PNS) is minimal due to the limited number of neuromodulation systems capable of targeting the distal part of lower limbs.…”

Section: Introductionmentioning

confidence: 99%

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Peripheral nerve stimulation for the treatment of chronic knee pain

Früh,

Sargut,

Hussein

et al. 2023

Sci Rep

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The average age of our population is increasing, resulting in a high incidence of chronic degenerative knee pathologies. Several treatment options, including surgical procedures are available to help mitigate these pathologies. However, the percentage of subjects with chronic post-surgical knee pain is still estimated at 16–20%. Neuromodulation techniques such as spinal cord stimulation and dorsal root ganglion stimulation (DRGS) are treatment options for subjects with chronic knee pain. The evidence for peripheral nerve stimulation (PNS) is minimal due to a limited number of neuromodulation systems capable of targeting the distal part of the lower limbs. This study aimed to investigate the safety and efficacy externally powered PNS systems for the treatment of chronic intractable knee pain targeting the saphenous nerve. Patients suffering from chronic intractable post-surgical knee pain received landmark-guided peripheral nerve stimulation of the branches of the saphenous nerve. All implants were performed with an externally powered PNS system to avoid lead migration as a result of cross-joint lead positions tunneling towards an Implantable Pulse Generator to the trunk. Data were collected retrospectively. Subject-reported outcome was measured via numerical rating scale values on a 10-point scale measuring pain intensity at rest and in motion. Additional data were collected for the subjects treated at the Charité location, including quality of life with the SF-36 form, quality of sleep with the Pittsburgh Sleep Quality Index and mood states with the short form of the General Depression Scale. Thirty-three patients received direct to permanent implant, landmark-guided peripheral nerve stimulation of the saphenous nerve branches. Six (18.2%) subjects reported non-sufficient initial benefit from the therapy and were explanted. Two subjects were explanted due to wound infections. The total study population reported included 25 patients. These subjects reported significant improvements related to pain, quality of life, mood quality, and quality of sleep. Additionally, subjects were able to reduce their opioid medication significantly after PNS therapy. Externally powered PNS at the saphenous nerve branches is a straightforward, selective and safe technique for patients with chronic knee pain. The landmark-guided implantation technique is less invasive than classical neuromodulation techniques such as spinal cord or DRGS and complication rates remain low. Short-term results are promising and show considerable reductions in pain scores and opioid intake. Long-term results are pending.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Peripheral nerve stimulation for the treatment of chronic knee pain

Früh,

Sargut,

Hussein

et al. 2023

Sci Rep

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“…Post-surgical joint pain or causalgia of the post-surgical joint is a PSPS that has garnered little attention with SCS compared with DRG-S. [118][119][120] There have been 2 prospective studies, 1 retrospective, 1 case series, 3 case reports, and 1 subset analysis of the ACCURATE study representing 66 patients with post joint replacement pain. 99,102,104,[121][122][123][124] The evidence DRG-S has demonstrated in post-surgical joint pain/causalgia compared to SCS places DRG-S as the authors' preferred neuromodulatory option in refractory post-surgical joint pain/causalgia.…”

Section: Post-surgical Joint Painmentioning

confidence: 99%

Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience

Chapman¹,

Sayed²,

Lamer³

et al. 2023

JPR

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With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain.

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