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Abstract
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Background and Aims Chronic neuropathic pain resulting from herpes zoster infection presents significant challenges in pain management. We present the case of a 73-year-old male referred to the chronic pain unit for management of severe neuropathic pain in the territory of the superior branches of the left superficial cervical plexus. The aim of this case report is to show a different approach to peripheral subcutaneous field stimulation lead placement and selective neurostimulation.
Methods The patient presented chronic neuropathic pain of mean intensity of 8 Visual Analog Scale (VAS) resistant to medical therapy and pulsed radiofrequency that had previously undergone a single-shot block of the cervical superficial nerve with temporary pain relief. Peripheral subcutaneous field stimulation was proposed and accepted by the patient. Under ultrasound guidance, two subcutaneous leads were placed in the left superficial cervical plexus without complications. The two electrodes were placed parallel to each other, next to the greater auricular nerve and lesser occipital nerve, as shown in figure 1. The electrodes were tunneled for the posterior region of the left shoulder girdle. The external pulse generator was parameterized until total pain relief was achieved.
Results At the 1-month follow-up, the patient reported a mean pain intensity of 1-2 (VAS).
Conclusions Peripheral subcutaneous field stimulation shows promise as a therapeutic option for localized chronic neuropathic pain following herpes zoster and we intend to describe the new approach with two subcutaneous leads placed parallelly.
- Position of the two neurostimulation probes before tuneling