Optimized Neurotherapy With Electrical Stimulation: Combined Peripheral Nerve Stimulation and Nerve Management Procedures for Postamputation Pain

Ann Plast Surg. 2026 Apr 6. doi: 10.1097/SAP.0000000000004710. Online ahead of print.

ABSTRACT

BACKGROUND: Limb loss significantly impacts patients' well-being, with many experiencing chronic postamputation neuropathic pain, including painful neuromas. Current treatments seldom achieve reliable long-term relief. Evidence suggests that peripheral nerve stimulation (PNS) can serve as an adjunctive therapy for reducing pain and enhancing nerve regeneration when combined with advanced nerve management strategies, such as targeted muscle reinnervation (TMR) or regenerative peripheral nerve interfaces (RPNIs). We hypothesize that PNS with advanced nerve management strategies can reduce postamputation neuropathic pain and improve functional outcomes.

METHODS: A retrospective chart review was performed for patients undergoing PNS placement for symptomatic peripheral neuromas following upper and lower-extremity amputations between 2023 and 2024. Inclusion criteria included patients with peripheral neuromas following amputations who failed conservative management. Surgeries were performed by a multidisciplinary team and included TMR or RPNI followed by PNS placement. Patient demographics, surgical history, anatomic neuroma location, prior pain interventions, and complications were reviewed. Postoperatively, patients used the device 4 hours daily, with pain and functional outcomes measured at 3 and 6 months. Data were analyzed using the Fisher exact test for categorical variables, the unpaired t test for continuous variables, and Pearson correlation for pain duration relationships.

RESULTS: Eight male patients were included (mean age 45.6 ± 19.0 y). Five had lower-extremity and 3 had upper-extremity amputations. All patients received RPNI before PNS. PNS targets were the brachial plexus cord level and the sciatic nerve for upper and lower-extremity amputations, respectively. Following PNS placement, Numeric Rating Scale pain scores decreased from 8.5 ± 1.5 preoperatively to 2.0 ± 2.6 at 6 months (P < 0.001). PROMIS Pain Behavior scores improved from 61.4 ± 3.1 to 50.9 ± 5.9 (P < 0.01), and PROMIS Pain Interference scores decreased from 63.9 ± 4.0 to 51.5 ± 5.9 (P < 0.01). All patients adhered to recommended daily use for the first 3 months, and 87.5% continued beyond this period.

CONCLUSIONS: Peripheral nerve stimulation may reduce pain and improve function in amputees with nerve-related pain, particularly as bridge therapy before combined nerve management procedures take effect. These findings suggest PNS could serve as a useful adjunct in multimodal pain management approaches.

PMID:41940726 | DOI:10.1097/SAP.0000000000004710