BACKGROUND: Chronic pain in patients with multiple overlapping pain syndromes is often refractory to conventional treatments. Peripheral nerve stimulation (PNS) has emerged as a promising neuromodulation therapy, especially when spinal cord stimulation (SCS) is contraindicated or ineffective.

CASE REPORT: We present the case of a 68-year-old man with severe chronic pain in the left hand and wrist following carpal tunnel release surgery, superimposed on a background of cervical and lumbar radiculopathies, degenerative cervical spondylosis, sacroiliitis, and failed back surgery syndrome. Conservative therapies (including transcutaneous nerve stimulation, physical therapy, injections, and opioids) as well as an intrathecal pump and a thoracolumbar SCS trial were moderately successful in relieving chronic back pain but had failed to relieve his hand pain. The patient was not a candidate for a cervical SCS due to extensive cervical spondylosis and stenosis. The patient underwent a 10-day trial of an externally powered PNS system targeting the left median nerve at the wrist, achieving > 50% pain reduction. This was followed by permanent implantation of the PNS device. The intervention produced an immediate pain score reduction from 9/10 to 4/10, and at 12 months postimplant, the patient reported complete pain relief (0/10) with restored hand function, improved sleep, and quality of life. No device-related complications occurred, and no reprogramming was required.

CONCLUSIONS: In this complex pain patient, the externally powered Freedom® Peripheral Nerve Stimulator System provided effective, focal analgesia where other therapies (including SCS) were not effective or viable, highlighting the potential of PNS as a safe and efficacious treatment for postsurgical neuropathic pain of the upper extremity.

KEYWORDS: Peripheral nerve stimulation, carpal tunnel syndrome, chronic pain, median nerve, upper extremity, wrist pain