Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Chronic lower limb pain due to mononeuropathy can be highly debilitating, affecting quality of life both physically and psychosocially. Attention around peripheral nerve stimulation has heightened in recent years due to increasing data demonstrating positive outcomes in chronic pain management. This study discusses a case of chronic lower limb pain managed effectively with peripheral nerve stimulation of 2 key nerves in the lower extremity: the posterior tibial and common peroneal.
CASE REPORT: A 68-year-old man presented with squeezing and crushing pressure encasing the entire left foot and ankle, with paresthesias along the heel and arch while walking and sharp radiating pain at the medial ankle and along the arch when sitting. In addition, 3 to 4 evenings per week, episodes of sharp radiating pain between the calf and ankle would occur for several hours. The average foot and ankle pain was 7 of 10 on the Verbal Rating Scale (VRS), with the evening calf episodes averaging 10 of 10. Previous therapies included nonsteroidal anti-inflammatory drugs (NSAIDS), nerve blocks, nerve ablation, opioids, spinal cord stimulation (SCS), and intrathecal drug delivery, all of which resulted in minimal, temporary relief. After successful diagnostic nerve blocks, peripheral nerve stimulators were placed at the posterior tibial and common peroneal nerves providing significant relief.
CONCLUSION: Subthreshold peripheral nerve stimulation at the posterior tibial and common peroneal nerves has proven successful for a patient suffering from chronic, debilitating lower limb pain due to mononeuropathy; results included decreased chronic pain and fewer pain episodes as well as increased activity, better socialization, and a significantly improved quality of life.
KEY WORDS: Ankle, chronic pain, common peroneal, foot, lower limb, mononeuropathy, peripheral nerve stimulation, posterior tibial