Disclosures: Michael S. Eaton, DO: No financial relationships or conflicts of interest

Objective: Single-lead, percutaneous, intramuscular Peripheral Nerve Stimulation (PNS) of the axillary nerve has been shown to provide long-term pain relief in stroke survivors with chronic hemiplegic shoulder pain (HSP). The prescribed PNS dose is 20 seconds on, 10 seconds off for 3, 6, or 9 hours per day for 3 weeks. The purpose of this analysis is to determine whether there is a dose-response relationship.

Design: Pilot Randomized Controlled Trial Setting : Outpatient center Participants : Stroke survivors with chronic HSP

Interventions: Stroke survivors with chronic HSP were enrolled and randomized to receive one of 3 doses of PNS: 1) 3 hours per day (7,560 total contractions); 2) 6 hours per day (15,120 contractions); or, 3) 9 hours per day (22,680 contractions). Stimulation was delivered daily for 3 weeks.

Main Outcome Measures: Pain was assessed using the Brief Pain Inventory (short form) question 3 (BPI SF-3) at end of treatment (EOT), and every 4 weeks post treatment up to 12 weeks. The BPI SF-3 uses a 0-10 point scale to assess worst pain over the last week. The primary endpoint was pain levels at 12 weeks compared to baseline pain with > 30% reduction being clinically meaningful.

Results: 23 participants were enrolled. At 12 weeks after treatment, 16.6% of those randomized to the 3-hour treatment group showed clinically meaningful pain reduction, compared to 44.4% of those in the 6-hour treatment group, and 50% in the 9-hour treatment group. Conclusions: The results suggest that patients with chronic HSP have a greater likelihood of having clinically meaningful long-term pain reduction if PNS is used 9 hrs a day compared to 6 and 3 hrs a day.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dose-response-relationship-of-peripheral-nerve-stimulation-in-chronic-hemiplegic-shoulder-pain/