Peripheral Nerve Stimulation: A New Horizon for Traumatic Brachial Plexus Injury, A Case Report

Abstract

BACKGROUND: The management of traumatic brachial plexus injury is challenging. Treatment options consisting of physical therapy, pharmacologic therapy, and injection therapy often provide inadequate analgesia. Peripheral nerve stimulation (PNS) has emerged as a potential therapy for treatment of pain related to brachial plexus injury. CASE REPORT: We present a case of a 37-year-old man with painful ballistic trauma to multiple cords of the left brachial plexus refractory to medications and therapies. The patient was treated with a temporary 60-day PNS targeting the brachial plexus providing 90% improvement in pain intensity persisting 7 months postintervention. CONCLUSIONS: The case supports the efficacy of a temporary PNS system as a minimally invasive treatment option for brachial plexus injuries resulting in refractory neuropathic pain. Extended lead implantation of the temporary PNS device beyond the US Food and Drug Administration-approved 60 days may be of benefit to patients, although the potential risk of infection should be assessed and monitored. KEY WORDS: Traumatic brachial plexus injury, peripheral nerve stimulator, peripheral nerve stimulation, neuromodulation, neuropathic pain, case report