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Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity
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Optimized Neurotherapy With Electrical Stimulation: Combined Peripheral Nerve Stimulation and Nerve Management

Sneha Rao1, Emily Yanoshak2, Jesse Chou3

  • 1Department of Orthopedic Surgery, University of Virginia Health System.

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|April 6, 2026
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Summary

Peripheral nerve stimulation (PNS) combined with advanced nerve management significantly reduced chronic pain and improved function in amputees. This approach offers a promising adjunctive therapy for postamputation neuropathic pain.

Keywords:
neuromaneuromodulationperipheral nerve stimulatorregenerative peripheral nerve interfacetargeted muscle reinnervation

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Area of Science:

  • Regenerative medicine
  • Neurosurgery
  • Pain management

Background:

  • Limb loss frequently results in chronic postamputation neuropathic pain, often due to painful neuromas.
  • Current treatments for this pain offer limited long-term relief.
  • Peripheral nerve stimulation (PNS) shows potential as an adjunctive therapy for pain reduction and nerve regeneration when used with advanced nerve management strategies like TMR or RPNI.

Purpose of the Study:

  • To evaluate the efficacy of peripheral nerve stimulation (PNS) in conjunction with advanced nerve management strategies for reducing postamputation neuropathic pain.
  • To assess the impact of PNS on functional outcomes in amputees with symptomatic neuromas.

Main Methods:

  • A retrospective chart review of patients who underwent PNS placement for symptomatic neuromas post-amputation (2023-2024).
  • Procedures included Regenerative Peripheral Nerve Interfaces (RPNI) followed by PNS placement.
  • Pain and functional outcomes were assessed at 3 and 6 months post-operation.

Main Results:

  • Eight male patients with upper or lower-extremity amputations were included, all receiving RPNI before PNS.
  • Significant reduction in pain scores (Numeric Rating Scale: 8.5 to 2.0) and improvements in PROMIS Pain Behavior and Interference scores were observed at 6 months (P < 0.001).
  • High patient adherence to the prescribed daily PNS usage was noted.

Conclusions:

  • Peripheral nerve stimulation (PNS) demonstrates potential in reducing pain and enhancing function for amputees experiencing nerve-related pain.
  • PNS may serve as an effective bridge therapy while awaiting the effects of combined nerve management procedures.
  • These findings support the use of PNS as a valuable component of multimodal pain management strategies for amputees.