Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Chronic postoperative hip pain is estimated to occur in 10% to 35% of patients undergoing total hip replacement. Proximal peripheral neuropathic pain of the lateral femoral cutaneous and superior gluteal nerves has proven to be a difficult disorder to treat. Opioids are often ineffective in the treatment of neuropathic pain. Interventional methods such as peripheral nerve stimulation are minimally invasive options capable of relieving neuropathic pain. Stimulators powered by an implantable pulse generator (IPG), however, may not be suitable for peripheral nerve stimulation because of difficulty finding an appropriate pocket site. The introduction of wireless peripheral nerve stimulation has improved the ability to offer this modality.
CASE PRESENTATION: We present a case of proximal peripheral neuropathic pain of the lateral femoral cutaneous and superior gluteal nerves that failed all other treatment modalities including spinal cord stimulation and intrathecal drug delivery. Two quadripolar, tined, wireless electrode arrays were positioned over the lateral femoral cutaneous and superior gluteal nerves. A stimulation scheme with a pulse rate of 1.5 kHz and pulse width of 30 µs at 2.0 mA was tested and found effective.
CONCLUSION: This patient had proximal neuropathic hip pain and failed a variety of chronic pain treatment options, including conventional IPG-based spinal cord stimulation and an intrathecal drug delivery system. She was successfully treated with a wireless peripheral nerve stimulation system.
KEY WORDS: Hip pain, lateral femoral cutaneous nerve, peripheral nerve stimulator, peripheral neuropathy, superior gluteal nerve