title: Single-lead percutaneous peripheral nerve stimulation for the treatment of hemiplegic shoulder pain: a case series.
abstract: OBJECTIVE
  Previous studies demonstrated the efficacy of Intramuscular Nerve (IMN) therapy with a 4-lead percutaneous, peripheral nerve stimulation (PNS) system in reducing hemiplegic shoulder pain (HSP). This case series investigates the feasibility of a less complex, single-lead approach in reducing HSP.
  
  
  METHODS
  Eight participants received one percutaneous intramuscular lead in the hemiparetic deltoid muscle and were then treated 6 hours/day for 3 weeks. The primary outcome measure was the Brief Pain Inventory (Short-Form) Question 3 (BPI3), which queries worst pain in the last week on a 0 to 10 numeric rating scale. Secondary outcomes included pain interference (BPI9) and Medical Outcomes Study Short-Form 36 (SF-36v2). Primary and secondary outcomes were assessed at the end of treatment (EOT) and 1 and 4 weeks after the EOT.
  
  
  RESULTS
  All participants tolerated the treatment well with 96% compliance. All leads remained infection-free and were removed intact at the EOT. On average, participants exhibited 70% reduction in BPI3 at the EOT and 61% reduction at 4 weeks after the EOT. All participants satisfied the success criterion of at least a 2-point reduction in BPI3 at the EOT. Longitudinal analysis revealed significant treatment effect for BPI3 (F = 14.0, P < 0.001), BPI9 (F = 5.9, P < 0.01), and the bodily pain domain of SF-36v2 (F = 12.8, P < 0.001).
  
  
  CONCLUSIONS
  This case series demonstrates the feasibility of a single-lead, 3-week IMN therapy for the treatment of chronic HSP. Additional studies are needed to further demonstrate safety, efficacy, and long-term benefit, define optimal prescriptive parameters and dose, and expand clinical indications.
authors.affiliation: Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio 44109, USA. jchae@metrohealth.org
authors.forename: John
authors.initials: J
authors.lastname: Chae
authors.forename: Richard D
authors.initials: RD
authors.lastname: Wilson
authors.forename: Maria E
authors.initials: ME
authors.lastname: Bennett
authors.forename: Tina E
authors.initials: TE
authors.lastname: Lechman
authors.forename: Kathryn W
authors.initials: KW
authors.lastname: Stager
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010525:Peripheral Nerves / Q000502:physiology*; D020069:Shoulder Pain / Q000209:etiology / Q000628:therapy*; D020521:Stroke / Q000150:complications
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal