Peripheral Nerve Stimulation of Brachial Plexus Nerve Roots and Supra-Scapular Nerve for Chronic Refractory Neuropathic Pain of the Upper Limb.
OBJECTIVE
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).


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).


CONCLUSIONS
In this pilot study, SSN or BP roots PNS provided a relatively safe, durable and effective option to control upper limb neuropathic pain.
Pain Clinic, Clinique Saint Léonard Village Santé, Trélazé, France.
Bénédicte
B
Bouche
Department of Neurosurgery, CHU de Nice, Nice, France.
Marie
M
Manfiotto
Spine & Neuromodulation Unit, Department of Neurosurgery, Poitiers University Hospital, Poitiers, France.|PRISMATICS Lab, Predictive Research In Spine Management/Neuromodulation & Thoracic Innovations/Cardiac Surgery Lab, Poitiers University Hospital, Poitiers, France.
Philippe
P
Rigoard
Pain Clinic, Clinique Bretéché, Nantes, France.
Jean
J
Lemarie
Pain Clinic, Clinique Bretéché, Nantes, France.
Véronique
V
Dix-Neuf
Pain Department, CHU de Nice, Nice, France.|Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte-d'Azur, Nice, France.|INSERM/UdA, U1107, Neuro-Dol, Université d'Auvergne, Clermont-Ferrand, France.
Michel
M
Lanteri-Minet
Department of Neurosurgery, CHU de Nice, Nice, France.|Fédération Hospitalo-Universitaire INOVPAIN, Université Nice Côte-d'Azur, Nice, France.
Denys
D
Fontaine
D000328:Adult; D000368:Aged; D001917:Brachial Plexus; D059350:Chronic Pain / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000628:therapy*; D010865:Pilot Projects; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D034941:Upper Extremity
Brachial plexus; neuromodulation; neuropathic pain; peripheral nerve stimulation; supra-scapular nerve