Peripheral field stimulation for thoracic post herpetic neuropathic pain

• Post herpetic neuralgia is a chronic, debilitating pain with very few management options and is often refractory to treatment.
• All 4 patients in our study showed persistent improvement in their VAS pain scores with an average improvement of more than 75%.
• Peripheral field stimulation is a safe and effective modality for post herpetic refractory neuropathic pain.
• Surgical planning and technique are essential for the success of treatment.
• Long term prospective randomized controlled trials are required to validate the efficacy of this treatment modality in patients with this clinical conundrum.

ObjectivePost herpetic neuralgia is a chronic, debilitating pain with very few management options and is often refractory to treatment. We present our experience with a series of 4 patients who underwent subcutaneous peripheral field stimulation for treatment of thoracic post herpetic neuropathic pain.MethodsFour patients with intractable thoracic post herpetic neuropathic pain were operated after maximum medical treatment and a neuropsychological evaluation. Multiple percutaneous electrodes were placed in the subcutaneous plane in the region of pain for a 7-day trial. Following a successful trial (more than 50% reduction of pain), the electrodes were then internalized and attached to a pulse generator. Visual analog scores (VAS) were studied during the preoperative, immediate postoperative and last follow-up visits. Long-term treatment results were determined by retrospective review of medical records. Average follow-up period was 28.2 months.ResultsAll 4 patients showed persistent improvement in their VAS pain scores with an average improvement of more than 75%. There were no treatment failures and no complication requiring re-operation was reported.ConclusionPeripheral field stimulation for the treatment of post herpetic neuropathic pain is a safe and effective method for pain relief for an extremely complex problem with very few solutions. Patient selection and proper lead placement is most important for the success of treatment.