title: Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Low Back Pain: Two Clinical Case Reports of Sustained Pain Relief.
abstract: As the leading cause of disability among U.S. adults, chronic low back pain (LBP) is one of the most prevalent and challenging musculoskeletal conditions. Neuromodulation provides an opportunity to reduce or eliminate the use of opioids to treat chronic LBP, but the cost and invasiveness of existing methods have limited its broad adoption, especially earlier in the treatment continuum. The present case report details the results of a novel method of short-term percutaneous peripheral nerve stimulation (PNS) in 2 subjects with chronic LBP. At the end of the 1-month therapy, stimulation was discontinued and the leads were withdrawn. PNS produced clinically significant improvements in pain (62% average reduction in Brief Pain Inventory Question #5, average pain), and functional outcomes (73% reduction in disability, Oswestry Disability Index; 83% reduction in pain interference, Brief Pain Inventory). Both subjects reduced nonopioid analgesic use by 83%, on average, and the one subject taking opioids ceased using all opioids. The only adverse event was minor skin irritation caused by a topical dressing. The clinically significant improvements were sustained at least 4 months after start of therapy (79% average reduction in pain; both reported minimal disability; 100% reduction in opioids; 74% reduction nonopioids). The results reveal the utility of this novel, short-term approach and its potential as a minimally invasive neuromodulation therapy for use earlier in the treatment continuum to produce sustained pain relief and reduce or eliminate the need for analgesic medications, including opioids, as well as more expensive and invasive surgical or therapeutic alternatives.
authors.affiliation: Center for Clinical Research and Carolina's Pain Institute, Winston Salem, North Carolina, U.S.A.|Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, U.S.A.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Kapural
authors.affiliation: Center for Clinical Research and Carolina's Pain Institute, Winston Salem, North Carolina, U.S.A.|Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, U.S.A.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Gilmore
authors.affiliation: Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, U.S.A.|MetroHealth Rehabilitation Institute of Ohio, Cleveland, Ohio, U.S.A.
authors.forename: John
authors.initials: J
authors.lastname: Chae
authors.affiliation: Center for Clinical Research and Carolina's Pain Institute, Winston Salem, North Carolina, U.S.A.|Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, U.S.A.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Rauck
authors.affiliation: Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.|Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.affiliation: MossRehab, Elkins Park, Pennsylvania, U.S.A.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Saulino
authors.affiliation: SPR Therapeutics, LLC, Chapel Hill, North Carolina, U.S.A.
authors.forename: Amorn
authors.initials: A
authors.lastname: Wongsarnpigoon
authors.affiliation: SPR Therapeutics, LLC, Chapel Hill, North Carolina, U.S.A.
authors.forename: Meredith J
authors.initials: MJ
authors.lastname: McGee
authors.affiliation: SPR Therapeutics, LLC, Chapel Hill, North Carolina, U.S.A.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Boggs
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008159:Lumbar Vertebrae; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D013127:Spinal Nerves; D013995:Time
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid
keywords: back pain; chronic pain; disability; non-narcotic; nonopioid; pain; percutaneous; peripheral nerve stimulation