Peripheral Nerve Stimulation May Provide Long-Term Pain Relief for Leprosy-Related Mononeuropathy
"Leprosy remains a public health problem in developing countries and is an important cause of peripheral neuropathy."
Peripheral nerve stimulation may provide long-term pain relief in patients with painful mononeuropathy secondary to leprosy, according to a study published in Neuromodulation.
In this prospective case series, 23 participants (aged 32±8.3 years; 56.5% women) with painful mononeuropathy secondary to leprosy who were refractory to conservative treatment (including amitriptyline, nortriptyline, and gabapentin) and neurosurgical decompression were enrolled. Patients were treated with peripheral nerve stimulation for 7 days, using a temporary electrode connected to an external stimulator.
Patients who reported more than 50% pain relief after the procedure (10 of 23), evaluated with the Visual Analog Scale, had a stimulation device implanted and were assessed at 1, 3, 6, and 12 months after implantation.
At the 12-month follow-up, 6 of the 10 patients with the implanted stimulation device reported more than 50% pain reduction (average pain reduction, 75%; P =.0001), and 2 patients had a 30% reduction in pain levels compared with baseline. In addition, the doses of pain medications were reduced by 40% from preoperative levels. Two study participants died from acute myocardial infarction and ischemic stroke during the follow-up period, and 2 patients had electrode displacement requiring surgery for repositioning.
The study authors explained that "leprosy remains a public health problem in developing countries and is an important cause of peripheral neuropathy." They concluded that the results "suggest that [peripheral nerve stimulation] is feasible in this population and [may be] safe [in the long-term] for the treatment of painful mononeuropathy secondary to leprosy."
Freitas TDS, Fonoff ET, Marquez Neto OR, et al. Peripheral nerve stimulation for painful mononeuropathy secondary to leprosy: A 12-month follow-up study [published online October 29, 2017]. Neuromodulation. doi: 10.1111/ner.12714