Early Results of Optimized Nerve Management with Electrical Stimulation for Lower Extremity Neuroma 

  

Background: Neuromas can arise from various etiologies, including trauma or surgery, and untreated often lead to chronic and debilitating pain in the lower extremity. Previously described nerve management techniques are effective, however often require significant time for symptomatic improvement.  This study assessed the short-term efficacy of electrical stimulation (ES) with peripheral nerve stimulators in providing early pain relief for patients with symptomatic lower extremity neuromas.   

  

Methods: This single-institution, prospective, cohort study included adult patients with lower extremity neuritis or neuroma confirmed with a positive response to diagnostic ultrasound-guided local anesthetic injection with minimum of 3 months of follow-up. Patients underwent nerve management procedure (targeted muscle reinnervation or nerve allograft reconstruction) with concomitant peripheral nerve stimulator placement, StimRouter (Bioventus. Durham, NC) between December 2022 to May 2023. Patients were treated postoperatively with external field conductor set to symmetric waveform with phase duration of 100uSec and pulse rate of 80 Hz for 4 hours daily. Patient demographics, surgical details, and outcomes data were evaluated comparing preoperative and postoperative PROMIS (Patient Reported Outcomes Measurement Information System) scores. 

  

Results: Six patients (mean age: 49 ± 10) underwent nerve stimulator placement. Nerve injury locations included sural (n=3), medial plantar (n=1), tibial (n=1), superficial peroneal (n=1), and saphenous (n=1). Patients had undergone a mean of 4 previous lower extremity surgeries. Mean Brief Resilience Scale (BRS) was 3.03 ± 0.67.  At 3 month following electrical stimulation and nerve management, NRS Pain scores decreased from a mean of 8.5 ± 1.4 to 1.7 ± 1.2 (p <.05), PROMIS Pain Behavior scores decreased from 58.4 ±1 0.9 to 53.7 ± 5.8 (p = 0.4573), and PROMIS Pain Interference scores decreased from 66.9 ± 3.14 to 58.0 ± 2.3 (p <.05) 

  

Conclusion: Optimized neurotherapy with electrical stimulation is a safe intervention that can lead to improved short-term pain for patients with symptomatic lower extremity neuromas.