Post-herpetic neuralgia (PHN) is a chronic condition that is associated with a previous infection of varicella zoster. When PHN occurs, the typical presentation is a dermatomal eruption of lesions, patches or vesicles. The most common symptom associated with PHN is pain. [1, 2] This type of pain is also known to be resistant to typical methods of treatment.[2, 3] Although there have been case reports of PHN being treated with spinal cord stimulation [4], it is well described that coverage of chest and abdominal wall pain is difficult to obtain. The literature is scant with reports of using peripheral nerve stimulation to treat PHN. We present a case report of a patient with PHN who is successfully treated with peripheral nerve stimulation.

METHODS

We describe a 40 year old female who presented with PHN and complained of right upper abdomen pain overlying the area corresponding to the intercostal nerves T7, T8, and T9. The pain was burning, throbbing, and associated with allodynia. The patient failed conservative management including medications, TENS, and intercostal nerve blocks. After appropriate evaluation by a pain psychologist we proceeded with a peripheral nerve stimulator trial. Two octad leads (Advanced Neuromodulation Systems Plano, Texas) were placed in the sub-cutaneous plane overlying the T7 and T9 intercostal nerves. At follow up visit, she reported about 75-85% pain relief. She subsequently underwent permanent implantation of two 2 leads overlying T7, T9 and rechargeable implantable pulse generator.

RESULTS

At her last post-operative follow up visit, 3 months after her implant, she reports >80% pain relief. She also reports improved sleep, function, and reduced need for pain medications.

CONCLUSION

We report successful treatment of this chronic, difficult to treat condition with peripheral nerve stimulation. Long term follow-up and additional investigation is needed to determine efficacy of this treatment.