Temporary-to-Permanent Peripheral Nerve Stimulation Not Superior to Direct Implantation in Pain Relief

Compared with patients who receive a permanent implant directly (direct-to-permanent [DTP] approach), those who undergo a temporary peripheral nerve stimulation (PNS) trial before permanent implantation (temporary-to-permanent [TTP] approach) experience similar pain relief at 6 months and similar reductions in opioid use, according to study results published in Regional Anesthesia & Pain Medicine.

In a multicenter retrospective study, researchers compared pain relief, opioid consumption, and adverse events among adult patients with chronic neuropathic pain who received either TTP or DTP PNS implantation between 2014 and 2024. Patients had failed conventional therapies and were followed for at least 6 months. The researchers collected data were collected on demographics, pain characteristics, opioid and neuropathic medication use, adverse events, and device explantation. The primary outcomes were pain relief and opioid consumption at 6 months. Multivariable Tobit regression using a stepwise approach was employed for statistical analysis.

A total of 130 patients (mean age, 62.5 years; women, 59%) were included in the final analysis; 54 and 76 patients received TTP and DTP PNS implantation, respectively. Lower extremity (46.5%) and shoulder (23.3%) were the most common PNS targets. Most (80.0%) patients received a diagnostic nerve block before implantation. Baseline characteristics were generally similar between groups, except for a higher prevalence of depression among patients in the DTP vs TTP group (64.5% vs 46.3%, P =.039). Among patients in the TTP group, 83.3% received a 60-day trial lead and 16.7% received a 7 to 10-day trial.

At 6 months, patients in the TTP group reported slightly greater pain relief compared with those in the DTP group (56.7% vs 45.1%; mean difference [MD], 15.24%; 95% CI, -0.32 to 30.80; P =.052). Sensitivity analyses using multiple imputations yielded consistent results. Opioid use decreased modestly in both groups (TTP vs DTP, -3.1 vs -2.1 mg oral morphine equivalents [OME]) with no significant between-group difference (MD, -1.00; 95% CI, -4.57 to 2.57; P =.580).

At 12 months, pain relief remained numerically higher in the TTP group (54.2% vs 34.3%), though not statistically significant (P =.578). Opioid use increased more in the DTP vs TTP group at 12 months (9.1 vs 4.1 mg OME; P =.028), but data were limited due to 50% or greater missing follow-up.

No significant differences were observed in adverse events or device explantation.

Multivariable analysis identified TTP group status (P =.028) and never-smoking status (P =.023) as independent predictors of greater pain relief at 6 months.

Study limitations include selection bias, unmeasured confounders, and missing data.

The researchers concluded, “Both approaches demonstrate significant pain relief and opioid reduction compared with baseline prior to PNS therapy.”

Disclosure: Some study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Clinical Pain Advisor