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Published on: July 14, 2020
Prognostic Value of 60-Day Temporary Peripheral Nerve Stimulation in Predicting Analgesic Outcomes After Permanent
Ryan S D'Souza1, Yue Yu2, Jay Karri3
1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Background:
The clinical and prognostic value of 60-day temporary peripheral nerve stimulation (PNS) before permanent PNS implantation remains unclear yet has major implications for patient selection, cost-effectiveness, and procedural burden.
Materials And Methods:
This retrospective, multicenter cohort study included adults with chronic neuropathic pain who underwent 60-day temporary PNS followed by permanent PNS implantation across four academic medical centers. The primary outcome was the association between pain relief during temporary PNS and at six months after permanent implantation. Secondary analyses evaluated 1) moderators (age, sex, smoking status, and psychiatric history) that may influence the association between temporary PNS response and six-month permanent PNS response; 2) association between temporary PNS response and permanent PNS response at 12 months; 3) whether relief from a nerve block correlated with relief from temporary PNS and permanent PNS; and 4) longitudinal changes in pain relief across the PNS treatment continuum.
Results:
The study included 47 patients (mean age 61.0 ± 17.5 years, 59.6% female). Each 1% increase in pain relief from temporary PNS predicted a 0.89% increase in the underlying six-month pain relief after permanent implantation (95% CI, 0.27-1.52; p = 0.005). No association was found between temporary PNS response and 12-month outcomes after permanent implantation, or between nerve block response and outcomes at trial and 12 months. Each 1% increase in pain relief from blocks was associated with 0.36% increase in the underlying six-month pain relief after permanent implantation (95% CI, 0.00-0.72; p = 0.048). Longitudinal analysis showed decreasing relief over time, with mean reductions of 16.65% and 25.18% at six and 12 months after permanent implantation, respectively, relative to temporary PNS (p = 0.015 and p = 0.001, respectively).
Conclusion:
Temporary PNS provides prognostic value for six-month outcomes but does not predict 12-month pain relief after permanent implantation, suggesting limited long-term utility. These findings challenge the routine use of 60-day temporary PNS and support reevaluating payor-mandated two-stage approaches in favor of more individualized, cost-effective strategies.
