Peripheral Nerve Stimulation for Interscapular Neuropathic Pain
Mazin Al Tamimi, MD, FIPP1, Mindy N. Cohen, MD2, Heather R. Davids, MD1, Jason Krutsch, MD1 and Alexander Yakovlev, MD3, (1)Pain Medicine, University of Colorado Health Sciences Center, Aurora, CO, (2)Anesthesiology, University of Colorado Health Sciences Center, Aurora, CO, (3)Comprehensive Pain Management of the Fox Valley, Appleton, WI
INTRODUCTION
Neuropathic pain in the interscapular area that has failed conservative treatment presents a challenge to the treating physician. Spinal cord stimulation is increasingly being used to treat neuropathic pain; however, the interscapular area provides unique challenges because of the anatomic placement required when placing a spinal cord stimulator. Although successful subcutaneous peripheral nerve stimulation has been reported previously (1, 2), it has rarely been reported for use with interscapular neuropathic pain (3). We present a case report of a female patient with interscapular pain who was successfully treated with implantation of a peripheral nerve stimulator (PNS).
MATERIALS AND METHODS
We describe a female patient who underwent a PNS trial and implantation using two Octrode peripheral nerve stimulator leads [Advanced Bionics, Valencia, CA, USA]. This patient had previously failed medical management, intercostal nerve block, trigger point injections, facet block and TENS. The PNS trial was completed after evaluation by a pain psychologist. She reported 80-100% pain relief during the ten-day trial. Electrodes were placed subcutaneously, targeting the epicenter of the neuropathic pain. Intraoperatively, the patient reported good coverage of the area of pain. An Advanced Bionic Precision implantable pulse generator (IPG) was placed above the gluteal area. The leads were anchored to deep fascia with 0 silk suture. Wounds were closed in a layered fashion. Peripheral stimulator placement and IPG connection were confirmed with intraoperative fluoroscopy.
RESULTS
Pain level was measured with a visual analog scale. The patient reported an improvement from 7/10 before the PNS placement to 0-1/10 afterwards. After the PNS placement, we have been able to discontinue all narcotic and sleep aid medications. The patient reports improved functionality and high satisfaction with the results of the implant.
CONCLUSION
When treating neuropathic interscapular pain, peripheral nerve stimulation is an effective treatment option.
References
1. Alo KM, Holsheimer J. New Trends in Neuromodulation for the Management of Neuropathic Pain. Neurosurgery 2002; 50(4): 690-704.
2. Paicius RM, Bernstein CA, Lempert-Cohen C. Peripheral Nerve Field Stimulation in Chronic Abdominal Pain. Pain Physician 2006; 9: 261-266.
3. Majedi MP, Hu P, Illynski O, Al-Majadi A, O'Keeffe D. Subcutaneous Electrical Nerve Stimulation for Interscapular Neuropathic Pain. Proceedings from the 6th Meeting of the Neuromodulation Society of the United Kingdom and Ireland. October 19–21, 2006, Cork, Ireland.
© 2018 Клиника «МЕДЭЛЕКТ»
г. Москва, Спартаковский пер, д.2 стр. 5.
Телефон: (499) 281-61-47