Factors associated with implantable pulse generator site pain: A multicenter cross-sectional study

Authors

Heejung Choi, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Rishi Gaiha, Advocate Health - MidwestFollow
Susan M. Moeschler, Department of Anesthesiology, Mayo Clinic, Chicago, IL, USA.
Marcus A. Bendel, Department of Anesthesiology, Mayo Clinic, Chicago, IL, USA.
Zachary L. McCormick, Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
Masaru Teramoto, Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
Joshua M. Rosenow, Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Stephanie Kielb, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Michael J. Avram, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
David R. Walega, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Recommended Citation

Choi H, Gaiha R, Moeschler SM, et al. Factors Associated With Implantable Pulse Generator Site Pain: A Multicenter Cross-Sectional Study. Neuromodulation. 2021;24(8):1351-1356. doi:10.1111/ner.13317

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Objectives: Implantable pulse generator (IPG) site pain following neuromodulation procedures is a recognized complication. The site of the IPG placement varies depending on the neuromodulation type and physician preference. The incidence of IPG site pain as a function of the site of IPG implantation has not been studied systematically.

Materials and methods: We performed a multicenter cross-sectional survey of the incidence, severity, and quality of IPG site pain, location of the IPG, the pain management needs, functional impairment, and cosmetic appearance related to the IPG placement. Contingency table analysis was conducted for categorical variables, and logistic regression analysis and linear regression model was used.

Results: The survey response rate was 60.5% (n = 510). Overall, 31.0% of patients reported pain at the IPG site in the last 72 hours with 31.4% reporting moderate to severe pain and 7.6% reporting severe pain. Older age was inversely associated with IPG-related pain (OR = 0.97, 95% CI = 0.96-0.99, p = 0.001). IPG implantation site did not have a statistically significant interaction with IPG site pain (p > 0.05). The most important factor for IPG site-associated pain was having a spinal cord stimulator implanted as compared to a deep brain stimulator, or sacral nerve stimulator. Most subjects reported no functional impairment related to IPG site pain (91%), found the IPG site pain as expected (80%), and found IPG site cosmetic appearance as expected (96%).

Conclusions: The incidence of IPG site pain is an important complication of invasive neuromodulation. The anatomic location of the IPG placement does not appear to affect the incidence or severity of IPG site pain. However, the presence of a pre-implant chronic pain disorder does appear to affect the frequency and severity of IPG site pain.

Type

Article

PubMed ID

33222364