Neuromuscular Stimulation of the Common Peroneal Nerve: Improved Pain Trajectory in Chronic Venous Leg Ulcers.

Background: Pain is among the most problematic aspects of chronic wounds. It adversely affects not only physical function but also social and psychological aspects of life. In concert, these effects can seriously impinge on quality of life. Despite affecting up to 80% of patients with leg ulcers, pain is reported to be under-treated. Methods: A secondary, within-subject controlled study design comparing wound pain intensity using a visual analogue scale of venous leg ulcer patients over 4 weeks receiving different interventions. In total, 29 patients received multi-layer compression over 4 weeks, followed by neuromuscular stimulation (NMES) of the leg muscle pump in addition to compression for a further 4 weeks. Paired comparison was then made of the pain gradient (rate of change in pain) between the two phases. A second cohort of 22 patients received only multi-layer compression throughout both 4-week phases. The trial was reported following the CONSORT guidelines. Results: Introduction of NMES at week 4 was accompanied by a significant increase in the rate of pain reduction over the following 4 weeks. Patients receiving standard care for the second 4-week phase experienced no change in the pain trajectory. Conclusions: 1 Hz NMES of the common peroneal nerve to activate the leg muscle pump is accompanied by an improved pain trajectory in patients with chronic venous leg ulcers. This mirrors the improvement in the rate of reduction in wound size previously reported in the same cohort. Pain is a common feature of chronic wounds and mitigation of pain is likely to have a profound impact on the quality of life of individuals with chronic venous leg ulcers.