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Abstract
Background and Aims Neuropathic pain is a major cause of disability worldwide. Managing peripheral neuropathic pain is a challenge demanding high doses of multiple analgesic agents together with interventional techniques. Peripheral nerve stimulation is an emerging field in minimal invasive techniques. A wire- like electrode is placed subcutaneously parallel to the nerves, involved with the area of pain distribution and connected with a small electrical device nearby, which delivers rapid electrical pulses bypassing the sensation of pain.
Peripheral nerve stimulation trial device
Peripheral nerve stimulation permanent device
Surgical implementation of PNS device
Methods This study reports 2 cases, a 44 and a 51-year-old male, without comorbidities, who suffered from post-traumatic neuropathic pain in the forearm along the ulnar nerve. After physiotherapy protocols, several attempts for surgical decompression and therapeutic peripheral nerve blocks, the patients continued to present severe pain refractory to medication. In both patients, after locating the trajectory of ulnar nerve with ultrasounds, under locoregional anesthesia, we placed subcutaneously an eight -polar electrode connected with an external temporary neurostimulator and after a 7-days trial period of complete pain relief, we implanted a permanent neurostimulator subcutaneously.
Results Both patients were successfully treated as evidenced by 75% reduction in symptoms and discontinuation of medication. Both patients present with more than 75% reduction in pain after 1 year and 8 months follow-up respectively. None of the patients receives pain medication systematically anymore.
Conclusions Placement of peripheral nerve stimulators could significantly change health care practice patterns and could substantially impact patient satisfaction and quality of life, providing a safe alternative to intractable neuropathic pain. However, more studies need to be conducted to prove their efficacy.