gms | German Medical Science

Objective: Peripheral nerve stimulation (PNS) is known to deliver targeted relief of neuropathic pain. Little is known about optimal stimulation strategies to ensure lasting and stabile effects. Some specific effects of PNS are based on sustained excitability of the stimulated axons. Since tonic stimulation inevitably leads to loss of excitability, cycling stimulation might be the logic consequence. Clinical observations made in our series of 32 patients with a PNS device and advantages of a standardized stimulation paradigm are presented.

Methods: 21 patients previously implanted with a PNS device and programmed with a tonic stimulation mode were analyzed regarding stimulation side effects, effect stability and personal use of the patient programmer. According to this analysis, 11 consecutive patients implanted thereafter were set on a tonic stimulation mode for 1 week and changed to cycling mode 30 min ON 1 hour OFF for another week. Side effects, effect stability, personal use of the patient programmer and patient satisfaction were compared.

Results: 19 out of 21 patients reported intermittent stimulation and 16 frequent stimulation side effects such as stimulation-induced pain and motor reactions in the retrospective analysis. During the following trial 8 out of 11 patients returned with stimulation-induced pain during the first week and requested reprogramming. With cycling stimulation 10 patients reported stabile and satisfactory pain suppression. Only 3 patients reported discomfort and requested reprogramming.

Conclusions: Cycling stimulation for PNS seems to be the method of choice to ensure stable and satisfactory results. It supports effect mechanisms of PNS adequately.