Proof of Concept and Feasibility of Motor Peripheral Nerve Stimulation for Chronic Postsurgical Pain After Total Knee Arthroplasty: A Case Series.

Abstract

Chronic postsurgical pain is prevalent in 13%-39% of patients after total knee arthroplasty. This can reduce function and quality of life, yet standard treatment options are limited. There remains a need for effective treatment options. Percutaneous motor peripheral nerve stimulation is a minimally invasive procedure that stimulates motor endpoints to produce muscle contraction of muscles near the painful region. Proof of concept and feasibility of motor peripheral nerve stimulation in chronic postsurgical pain after total knee arthroplasty have not yet been established. We report a series of five cases of motor peripheral nerve stimulation for refractory knee pain after total knee arthroplasty. The primary endpoints for feasibility were adherence related-all five individuals continued stimulation treatment through the 60 day period, five volitionally maintained stimulation for more than 80% of the time, and three of five volitionally maintained stimulation for more than 90% of the time (average 89.7%). Six months after motor peripheral nerve stimulation treatment, three out of five patients continued to have pain relief as measured by the Brief Pain Inventory-Short Form at 0 through 24 wks after implant. Three responders had a mean baseline worst pain of 6.66 reduce to 2 at 6 mos after implant. Motor peripheral nerve stimulation is feasible and may offer effective treatment for chronic refractory pain after total knee arthroplasty.