Persistent pocket-site pain after cardiac implantable electronic device implantation: a prospective observational study of prevalence, neuropathic characteristics, and quality of life

Although transvenous cardiac implantable electronic device (CIED) implantation is generally considered a minor procedure, long-lasting pocket-site pain may represent an underrecognized clinical problem. This study aimed to evaluate the prevalence, characteristics, and clinical impact of persistent pain after CIED implantation. This prospective observational study included patients who underwent first-time CIED implantation and attended routine outpatient follow-up visits. Pain intensity was assessed using the Visual Analog Scale (VAS), and neuropathic pain characteristics were evaluated using the Douleur Neuropathique 4 Questions (DN-4) questionnaire. Health-related quality of life was assessed using the Short Form-12 (SF-12). Demographic and clinical data were also recorded. A total of 102 patients were included in the analysis. Persistent implantation-site pain (VAS ≥ 4) was reported by 22.5% of patients. Neuropathic pain characteristics (DN-4 ≥ 4) were identified in 26.5% of patients. A moderate positive correlation was observed between VAS and DN-4 scores (ρ = 0.473, p < 0.001). However, the association between VAS ≥ 4 and DN-4 ≥ 4 was not statistically significant and had a small effect size ( p = 0.118; φ = 0.15). Pain intensity was moderately negatively correlated with the SF-12 physical component score, indicating reduced physical quality of life with increasing pain severity, while mental quality of life was not significantly affected. Persistent pocket-site pain after CIED implantation affected a clinically meaningful proportion of patients despite generally low overall pain scores. Higher DN-4 scores were associated with poorer physical and mental quality of life and may provide additional clinical information in selected patients. However, because the categorical association between VAS-defined persistent pain and DN-4 positivity was not statistically significant, these findings should be interpreted cautiously and confirmed in larger prospective studies.