Peripheral nerve stimulation - Our experiences with the wireless high-frequency system

Peripheral nerve stimulation using a wireless high-frequency system offers an alternative to neurostimulator implantation. This approach has the potential to reduce the treatment's risk profile and improve overall quality of life.

Between January 2021 and October 2024, 21 patients were treated at our clinic using a wireless high-frequency system for peripheral nerve stimulation (PNS). The system was implanted under local anesthesia via a Tuohy needle puncture, with ultrasound guidance. The mean surgical time was 36 min (range 16 - 60 min). All patients presented with long history of chronic pain syndromes (mean 49 months, range 8-96 months) and had previously undergone multimodal pain therapy in specialized centers. The most common causes of pain were patients after traumatic peripheral nerve surgery (n = 10, 47.7%) followed by pain after previous surgeries (n = 8, 38.1%) and 3 patients (14.1%) with peripheral nerve tumors. The most common nerve targeted for stimulation was ulnar nerve (n = 7, 33.3%), followed by peroneal nerve (n = 4, 19%), tibial nerve (n = 3, 14.3%), median nerve (n = 3, 14.3%), occipital nerve (n = 2, 9.5%), infrapatellar nerve (n = 1, 4.8%) and medial antebrachii cutaneous nerve (n = 1, 4.8%). All patients reported preoperative neuropathic pain, with NRS (Numeric Rating Scale) scores ranging from 7/10 to 10/10 (mean 8.2/10).

Pain reduction was achieved in 17 (81%) patients, with NRS scores decreasing from 8.2/10 preoperatively to 4.3/10 postoperatively (mean reduction of 5.2/10). Additionally, 14 (66.7%) patients experienced a reduction in their pain medication use, with some patients completely discontinuing their medication.However, no positive effects were observed in the patient receiving median nerve stimulation due to a tumor and previous fascicle biopsy, nor in the two patients with a history of lacerations and partial nerve transplants, despite correct pain area coverage.19 (90.5%) patients would choose peripheral nerve stimulation again.In most patients (94%, n = 16/17), stimulation was applied twice daily for 30 min. Additionally, 7/17 (41.2%) patients used the system to manage acute pain attacks. No infections, wound healing or other complications were reported in any patient.

Peripheral wireless high frequency stimulation is a simple and feasible option for patients with chronic pain syndrome within the territory of a specific peripheral nerve. In patients with prior partial nerve grafting, seems to be the introduced system less effective, despite correct coverage of the pain area.