Clinics in Medicine and Medical Research | Volume 4, Issue 1 | Review Article | Open Access DOI
Suresh Srinivasan, MD*
Suresh Srinivasan, MD¹*, Kiran Khurshid MD2 , Uzam Hussain MD2 , Joseph Pathakamuri3, Mohanraj Palani Selvam MD3
1Department of Pain Medicine, Trinity Health System, Steubenville,OH, USA (ORCID ID: 0000-0002-1363-4518)
2Internal Medicine Residency Program, Trinity Health System,Steubenville, OH, USA (ORCID ID : 0000-0002-4897-6059 )
3Department of Biology, Franciscan University of Steubenville, OH, USA (ORCID ID: 0000-0002-2791-7359)
4Department of Biochemistry, All India Institute of Medical Sciences, Gorakhpur, India (ORCID ID:0000-0002-0943-8709 )
*Correspondence to: Suresh Srinivasan, MD
Fulltext PDFBackground: Persistent pain can complicate recovery after critical illness, but neuropathic pain remains incompletely characterized. Critical illness polyneuropathy, small-fiber injury, and focal peripheral nerve injuries may produce persistent pain alongside weakness, cognitive impairment, and psychological distress.
Objective: To critically synthesize the rationale and evidence for peripheral nerve stimulation (PNS), dorsal root ganglion stimulation (DRGS), and spinal cord stimulation (SCS) after critical illness and propose a framework for prospective evaluation.
Methods: This narrative review integrates critical-care survivorship literature, neurological diagnostic frameworks, selected neuromodulation trials and evidence syntheses, and procedural guidance. References were checked against accessible PubMed-indexed records and journal sources through October 4, 2026. Evidence concerning ICU survivors is distinguished from indirect evidence in analogous pain populations; no systematic-review or PRISMA-ScR compliance is claimed.
Findings: Post-ICU chronic-pain estimates encompass multiple mechanisms and cannot be equated with neuropathic-pain prevalence. Neuromodulation trials in peripheral nerve pain, postamputation pain, complex regional pain syndrome, and painful diabetic neuropathy provide a translational rationale, but do not establish efficacy after critical illness. A proposed framework considers PNS for anatomically localized peripheral nerve pain, DRGS for selected focal regional pain, and SCS for selected bilateral or multisegmental peripheral neuropathic pain. Medical stabilization, neurological diagnosis, rehabilitation, psychological assessment, and procedural safety evaluation precede consideration of invasive treatment.
Conclusions: Neuromodulation warrants prospective investigation for persistent neuropathic pain after critical illness. Multidisciplinary follow-up, phenotype-specific enrollment, comparative studies, and patient-centered functional outcomes are needed before routine use for this indication can be supported.
Critical illness; Post-intensive care syndrome; neuropathic pain; critical illness polyneuropathy; peripheral nerve stimulation; dorsal root ganglion stimulation; spinal cord stimulation
Suresh Srinivasan, Kiran Khurshid, Uzam Hussain, Joseph Pathakamuri, Mohanraj Palani Selvam. Neuromodulation for Refractory Neuropathic Pain Following Critical Illness: A Narrative Review and Phenotype-Based Clinical Framework. Clin Med and Med Res. 2026;4(1):1-23.