Pain incidence after thoracic surgery is a common problem which often becomes chronic (1). The literature indicates that over 50% of patients report post-thoracotomy pain that persists greater than one year (2,3). Treating this pain has proven to be difficult as it is often refractive to common therapies. Spinal cord stimulation has occasionally been reported as a treatment for post-thoracotomy pain (4); however, there are no literature reports of successful treatment with peripheral nerve stimulation (PNS). We present a case report of a patient with post-thoracotomy pain who was successfully treated with implantation of a peripheral nerve stimulator (PNS).

MATERIALS AND METHODS

We describe a 65 year old woman who underwent a PNS trial and implantation using one Octrode lead and two Quad leads [Advance Neuromodulation Systems, Plano, TX]. The patient presented to Pain Clinic with chest wall pain status post a thoracotomy to perform a diaphragmatic plication. This patient failed treatment with medications. She also failed TENS unit and intercostal nerve blocks. After evaluation by a pain psychologist, the patient underwent an eight day PNS trial, during which the patient reported significant pain relief. Permanent placement was then performed. The electrodes were placed subcutaneously over the area covering the epicenter of the pain. An ANS implantable pulse generator was placed in the left lower abdominal quadrant. Incisions were closed in a layered fashion.

RESULTS

The patient continued to report greatly improved pain level after permanent PNS placement. She rated her pain 0/10 on a VAS 4 weeks after the procedure. One year after the procedure, the patient no longer requires treatment with narcotics and her use of anti-epileptics has decreased significantly. The patient also reports increased quality of life and daily function.

CONCLUSION

Peripheral nerve stimulation may be an effective treatment option when treating post-thoracotomy pain.