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A Novel Minimally Invasive Wireless Technology for Neuromodulation via Percutaneous Intercostal Nerve Stimulation for Post‐Herpetic Neuralgia: A Case Report with Short‐Term Follow‐up
Author(s) -
Billet Bart,
Wynendaele Roel,
Vanquathem Niek E.
Publication year - 2018
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12607
Subject(s) - medicine , intercostal nerves , neuromodulation , dermatome , surgery , anesthesia , transcutaneous electrical nerve stimulation , neuralgia , chronic pain , neuropathic pain , stimulation , alternative medicine , pathology , psychiatry
Background Peripheral nerve stimulation of primary afferent neurons provides control of localized chronic pain. This technique applies permanent electrical stimulation at the target area via a minimally invasive, subcutaneous placement of an electrode. Objective To assess the analgesic effects of minimally invasive wireless neuromodulation in the treatment of chronic intractable pain secondary to post‐herpetic neuralgia. Case Summary A 78‐year‐old man presented with severe intractable post‐herpetic neuralgic pain. He was known to have non‐Hodgkin's lymphoma under remission following treatment with chemotherapy and stem cell transplantation, twice. He also developed steroid‐induced diabetes mellitus during this treatment. In view of his compromised immune status, he was deemed a suitable candidate for our minimally invasive neuromodulation technology. Two subcutaneous electrodes were placed on the right‐hand side of the trunk, 10 cm medial and parallel to the spinous process at the level of T7–T8 under fluoroscopic guidance along the T7 intercostal nerve. The external transmitter was worn with a belt over a single layer of clothing and used to transmit power to the stimulator. The entire procedure required only a small incision for the introduction of the electrode placement. Results After an uneventful procedure, the pain score decreased from 8 to 3, with a reduction in pain medication. The EuroQol Five Dimensions Questionnaire scores were 0.102 before the trial, 0.630 at 1 month, and 0.576 at 3 months. Conclusions Subcutaneous placement of electrodes with our minimally invasive technique and wireless neuromodulation technology was safe and effective. Significant improvements in pain relief ensued, and no further adverse events had been reported at the end of 3 months' follow‐up.