Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: The mechanistic underpinnings of nerve stimulation technology is an area of active debate in interventional pain literature. Whether the technology is transcutaneous, subcutaneous, or directly on the spinal cord/dorsal root ganglion, there are ample theories without substantive evidence. Although, these technologies have been proven to be invaluable for pain relief. Direct spinal cord stimulation is purported to be effective for peripheral pain through centrally mediated stimulation. However, in select cases, there is evidence for superior analgesia from a peripherally directed device, such as a subcutaneously placed peripheral field nerve stimulator (PFNS), when compared to spinal cord stimulators (SCS).
CASE REPORT: An 81-year-old man was referred for left upper thoracic pain exacerbated by lipoma excision with diagnostic imaging unsupportive of musculoskeletal etiology. The patient was found to have soft tissue tenderness to palpation worsened by activity. He failed numerous conservative treatments and procedures. An epidural SCS was trialed, with appropriate paresthesia mapping, but was unsuccessful in providing significant relief. Ultimately, a PFNS was trialed and found to provide adequate relief. A PFNS was later implanted, resulting in successful pain relief.
CONCLUSION: The case demonstrates the importance of developing evidence-based guidelines for the application of PFNS. Additionally, it is important to delineate the shared and unique targets of nerve stimulator technologies so that patients may minimize risk through trial-and-error procedures.
KEY WORDS: Surgical procedures, operative, spinal cord stimulation, refractory pain, paroxysmal nerve pain, intractable pain, electric stimulation therapy, back pain without radiation, transcutaneous electric nerve stimulation