title: Combined Spinal Cord Stimulation and Peripheral Nerve Stimulation for Brachial Plexopathy: A Case Report.
abstract: Brachial plexopathy usually results from an iatrogenic brachial plexus injury and can sometimes cause severe chronic pain and disability. There are a number of possible treatments for this condition, including medication, physical therapy, nerve blocks, and neuromodulation, but they are not always successful. Recently, combined spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been tried for various chronic pain diseases because of their different mechanisms of action.Here, we describe the case of a 54-year-old man who was diagnosed with brachial plexopathy 8 years ago. He underwent video-assisted thoracoscopic surgery to remove a superior mediastinal mass. However, his brachial plexus was damaged during the surgery. Although he had received various treatments, the pain did not improve. For the management of intractable severe pain, he underwent SCS 2 years ago, which initially reduced his pain from numeric rating scale (NRS) 10/10 to NRS 4 - 5/10, but the pain then gradually increased, reaching NRS 8/10, 6 months ago. At that time, he was refractory to other treatments, and we therefore applied PNS in combination with SCS. The PNS electrode was positioned on the radial nerve under ultrasound guidance. After combined PNS and SCS, his background pain disappeared, although a breakthrough pain (NRS 3 - 4/10) was caused intermittently by light touch. Furthermore, the patient's need for analgesics decreased, and he was satisfied with the outcome of this combined treatment. We concluded that combined SCS and PNS is a very useful treatment modality, which can stimulate the target nerve both directly and indirectly, and hence, relieve pain from brachial plexopathy.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Shu Chung
authors.initials: SC
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Dong Kyu
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Choon Ho
authors.initials: CH
authors.lastname: Sung
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Chon
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ho Sik
authors.initials: HS
authors.lastname: Moon
mesh_terms: D001917:Brachial Plexus / Q000000981:diagnostic imaging / Q000293:injuries; D020516:Brachial Plexus Neuropathies / Q000000981:diagnostic imaging / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000628:therapy; D010525:Peripheral Nerves; D011183:Postoperative Complications; D011826:Radial Nerve; D062187:Spinal Cord Stimulation / Q000379:methods*; D018084:Ultrasonography, Interventional