SLR - February 2024 - Knapp
Title: Efficacy of Peripheral Nerve Stimulation with a High Frequency Electromagnetic Coupled (HF-EMC) Powered Implanted Receiver in Treating Different Pain Targets/Neuralgias.Reference: Abd-Elsayed A, Moghim R. Efficacy of Peripheral Nerve Stimulation with a High Frequency Electromagnetic Coupled (HF-EMC) Powered Implanted Receiver in Treating Different Pain Targets/Neuralgias. J Pain Res. 2023 Feb 23;16589-596.
Level of Evidence: IV
Reviewed by: Derek Knapp, DPM
Residency Program: Creighton University School of Medicine-Phoenix, Phoenix, AZ
Podiatric Relevance: Chronic pain is one of the most common and difficult musculoskeletal pathologies to treat globally. When patients do not respond to conservative therapy, opioids have been used. Although mildly/ moderately effective, in recent years, the opioid epidemic has become a nationwide concern due to a direct correlation with drug abuse. The podiatric physician often comes across patients who deal with chronic foot and ankle pain that is caused by peripheral neuropathy, arthritis, tendinopathies, CRPS, neuromas, and more. This study aims to show an alternative treatment to chronic pain throughout the body by the use of an implanted percutaneous peripheral nerve stimulator (PNS).
Methods: A single-center retrospective study was performed with an experienced physician implanting the PNS device into target nerves throughout the body. The PNS device (Curonix, formerly Stim Wave technologies) uses high-frequency electromagnetic coupling technology to create an electrical field that acts on the nerves to inhibit the transmission of pain signals to the brain. This review included 57 patients who received PNS for the treatment of chronic pain in various sites for different durations of follow-up. Five patients were implanted with 1 lead and 52 patients were implanted with 2 leads. For appropriate placement, fluoroscopy was used in 42 implants, and combined fluoroscopy and ultrasound in 15 implants. Data collected from electronic medical records included patient demographics, pre- and post-implant pain scores, and adverse events. Data was also obtained to show differences in pre- and post-post implant morphine milliequivalent use (MME) of opioids at 6, 12, and 24 months.
Results: In the one-month follow-up group, mean pain score was reduced from 7.44±1.48 pre-procedure to 1.6±1.49 (N=57); 7.42±1.5 pre-procedure to 1.6±1.5 at 3 months (N=56); 7.52 ±1.5 to 1.72±1.57 at 6 months (N=50); 7.41±1.53 to 1.7±1.55 at 9 months (N=44); 7.41±1.58 to 1.76±1.63 at 12 months (N=34); 7.38±1.59 to 1.69±1.56 at 15 months (N=29); 7.5±1.7 to 1.45±1.57 at 24 months (N=20). The reduction in pain scores reported by the patients was statistically significant at all durations of follow up. Patients also reported significant reduction in opioid intake. The only complications occurred post-procedure with 2 patients receiving an explant and 1 patient with lead migration. Patients reported more than 70% improvement in pain at all follow-ups.
Conclusion: This study shows the efficacy of PNS in treating and managing chronic pain related to various musculoskeletal pathologies. With only 2 patients requiring explant, this study demonstrates that PNS is effective with good success rates. The implant device also demonstrates longevity and safety with noted excellent post-procedure pain scores extending up to 24 months. Less opioid dosing is needed to manage chronic pain when PNS was utilized in these patients.
Disclosure: Dr. Alaa Abd-Elsayed is Consultant of StimWave. Dr. Robert Moghim reports personal fees from Curonix outside the submitted work. The authors report no other conflicts of interest in this work.