23rd Annual Pain Medicine Meeting 2024

A “Stimulating” Case Report on Difficult to Control Chronic Lower Extremity Neuropathic Pain

Lucendia Adams, MD and Raheleh Rahimi Darabad, MD

Indiana University Department of Physical Medicine and Rehabilitation; Indiana University Department of Advanced Pain Therapies

INTRODUCTION

•Chronic pain affects approximately 50.2 million Americans daily

•Neuromodulation is a common technology to turn to when other modalities fail

•Spinal Cord Stimulators

•Paresthesia based vs Paresthesia free

•Continuous vs high frequency vs burst frequency

•Intrathecal Drug Pumps

•Peripheral Nerve Stimulators

- Temporary vs Permanent

CASE PRESENTATION

•59 year old female with history of congenital injury at birth resulting in chronic right lower extremity neuropathic pain

•Multiple surgeries: six right knee arthroplasties and femoral nail placement

•PO Pain Regimen:

•Norco 15mg BID

•Lyrica 100mg qHS(caused significant drowsiness)

•Underwent Spinal Cord Stimulator (SCS) placement 2020 (Paresthesia based/burst frequency model)

•Presented to clinic 2023 for second opinion à SCS causing significant painful paresthesia

INTERVENTION

•Attempted replacement to paresthesia free SCS but scar tissue significant àabandoned

•Given chronic opioid use, considered intrathecal pain pump, but unable to get intrathecal access àabandoned

•Temporary (60-day) Peripheral Nerve Stimulator (PNS) with two leads targeting femoral nerve à 80% relief in daily pain and reduced opioid dosing by 50%, but one lead dislodged and pain/opioid use increased

•Insurance approved repeat Temporary PNS à 85% pain relief and reduced opioid use by 75%, but when leads were removed pain/opioid use returned to baseline and now having significant constipation due to opioids

CONCLUSIONS

•Given excellent, but temporary, pain relief with 60 day PNS system à would be great candidate for permanent peripheral nerve stimulator àawaiting insurance approval

•Illustrates a complex case of chronic neuropathic pain after congenital injury and multiple extremity surgeries

•Highlights multiple treatment approaches and modalities as well as side effects/complications

23rd Annual Pain Medicine Meeting 2024

A “STIMULATING” CASE REPORT ON DIFFICULT TO CONTROL CHRONIC LOWER EXTREMITY NEUROPATHIC PAIN

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