The expanding role for peripheral nerve stimulation for patients with malignancy related bone pain
Poster #: 042
Session/Time: A
Author:
Casey Hadley Barry, BS
Mentor:
Matthew Chung, MD
Research Type: Case Report
Abstract
INTRODUCTION:
Improving quality of life for cancer patients, especially those suffering from cancer-induced bone pain (CIBP) depends upon effective pain management. CIBP management is complicated by its multifactorial etiology, both neuropathic and nociceptive, frequently resulting in persistent pain. Conventional CIBP management encompasses pharmacologic and interventional therapies as outlined by the World Health Organization (WHO) analgesic ladder. Insufficient outcomes from conventional management have generated increasing demand for supplementary interventional options to control CIBP. Peripheral nerve stimulation (PNS) represents one potential alternative to conventional management and alleviates pain through targeted neuromodulation of affected nerves. Although PNS is an established treatment modality for certain chronic pain conditions (e.g., mononeuropathies, occipital neuralgia, CRPS, etc.), its utility in cancer-related pain, particularly CIBP, remains largely untested.
CASE INFORMATION:
This retrospective case series describes five patients who underwent PNS implantation for unresolved CIBP despite conventional management. Participants included in this case series were all over 18 years old, had radiographically confirmed osseous metastasis, and presented to clinic with intractable CIBP. Patients had received PNS leads under anesthesia and were percutaneously implanted at predetermined nerve targets corresponding with the pain distribution. As part of their care all patients had pain intensity (Numeric Rating Scale, NRS), pain-related symptoms (Edmonton Symptom Assessment Scale, ESAS), opioid consumption (Morphine Milligram Equivalents, MME), subjective pain reduction, and functional status that had been assessed at baseline and at regular intervals following PNS implantation.
DISCUSSION/CLINICAL FINDINGS:
Due to early patient demise, one patient was excluded from data analysis. Three of the four remaining patients reported a reduction in pain intensity following PNS implantation, with a mean decrease in NRS of 2.7. Furthermore, all four evaluable patients reported substantial percentage reduction in pain ranging from 60-100%.
CONCLUSION:
In conclusion, this case series suggest that PNS can provide significant pain relief and improvements in functional status/quality of life for patients with uncontrolled CIBP. Consequently, PNS represents a valuable alternative therapeutic option for patients whose CIBP has previously been difficult to control. While promising, these findings are limited by the small sample size and retrospective design. Future studies involving larger, prospective, randomized control trials are necessary to further evaluate the efficacy of PNS in CIBP patients.
Improving quality of life for cancer patients, especially those suffering from cancer-induced bone pain (CIBP) depends upon effective pain management. CIBP management is complicated by its multifactorial etiology, both neuropathic and nociceptive, frequently resulting in persistent pain. Conventional CIBP management encompasses pharmacologic and interventional therapies as outlined by the World Health Organization (WHO) analgesic ladder. Insufficient outcomes from conventional management have generated increasing demand for supplementary interventional options to control CIBP. Peripheral nerve stimulation (PNS) represents one potential alternative to conventional management and alleviates pain through targeted neuromodulation of affected nerves. Although PNS is an established treatment modality for certain chronic pain conditions (e.g., mononeuropathies, occipital neuralgia, CRPS, etc.), its utility in cancer-related pain, particularly CIBP, remains largely untested.
CASE INFORMATION:
This retrospective case series describes five patients who underwent PNS implantation for unresolved CIBP despite conventional management. Participants included in this case series were all over 18 years old, had radiographically confirmed osseous metastasis, and presented to clinic with intractable CIBP. Patients had received PNS leads under anesthesia and were percutaneously implanted at predetermined nerve targets corresponding with the pain distribution. As part of their care all patients had pain intensity (Numeric Rating Scale, NRS), pain-related symptoms (Edmonton Symptom Assessment Scale, ESAS), opioid consumption (Morphine Milligram Equivalents, MME), subjective pain reduction, and functional status that had been assessed at baseline and at regular intervals following PNS implantation.
DISCUSSION/CLINICAL FINDINGS:
Due to early patient demise, one patient was excluded from data analysis. Three of the four remaining patients reported a reduction in pain intensity following PNS implantation, with a mean decrease in NRS of 2.7. Furthermore, all four evaluable patients reported substantial percentage reduction in pain ranging from 60-100%.
CONCLUSION:
In conclusion, this case series suggest that PNS can provide significant pain relief and improvements in functional status/quality of life for patients with uncontrolled CIBP. Consequently, PNS represents a valuable alternative therapeutic option for patients whose CIBP has previously been difficult to control. While promising, these findings are limited by the small sample size and retrospective design. Future studies involving larger, prospective, randomized control trials are necessary to further evaluate the efficacy of PNS in CIBP patients.