Optimizing Lead Placement in Peripheral Nerve Stimulation for Improved Clinical Outcomes in the Treatment of Chemotherapy-Induced Peripheral Neuropathy: A Case Series

Background/Objectives This case series investigates the hypothesis that optimizing lead placement for peripheral nerve stimulation (PNS) relative to symptomatic areas in chemotherapy-induced peripheral neuropathy (CIPN) enhances pain relief, improves neurological function, and leads to decreased opioid use. Methods We conducted a case series involving four adult patients diagnosed with CIPN, who reported moderate to severe pain (NRS ≥ 4). Patients received PNS with lead placement varying from proximal (L5/S1 nerve roots) to distal (saphenous/popliteal nerves at midthigh). Pain severity was measured using the Numeric Rating Scale (NRS) at baseline, 1 month, 2 months, and 3 months post-implantation. Neurological function was assessed using the Treatment Induced Neuropathy Assessment Scale (TNAS) at the same time intervals. A comparative analysis was conducted across different lead placement sites, assessing outcome measures such as pain scores and neurological function scores. Results Two patients receiving distal lead placement experienced significant pain relief, with reductions of 30-40% and 20-30% over three months, while proximal placements yielded only 10% relief. Neurological assessments indicated minimal improvement for two patients, but significant enhancements in tingling, pain, and sleep quality for those with distal placements. Patients with distally placed leads demonstrated a reduced need for opioids compared to those with proximally placed leads. Conclusion This case series suggests that strategically placing PNS leads closer to symptomatic areas improves clinical outcomes in CIPN treatment. These findings provide preliminary evidence supporting the importance of lead placement in PNS efficacy and highlight the need for larger, controlled studies to further validate these results and optimize treatment protocols for CIPN and other neuropathic conditions.