Peripheral nerve field stimulation following dorsal root entry zone lesion: a technical note

Peripheral nerve field stimulation (PNFS) can effectively manage pain localized to one or two dermatomes that are refractory to conventional approaches, such as chronic low back pain. However, its utility in pain management in the upper limbs is limited due to the risk of lead displacement related to articular and mobile segment constraints.

In this technical note, we describe a 58-year-old man with neuropathic pain refractory to extensive medical treatment, and dorsal root entry zone lesion. Considering the patient’s favorable response to transcutaneous electrical nerve stimulation, we used a two-step lead placement approach to improve the permanent placement of the electrode leads in the upper limb. After 1 year follow-up, the patient achieved at least 50% pain relief, with no signs of lead displacement or resistance during flexion and extension movements of the involved upper limb, illustrating the success of PNFS.

Peripheral nerve field stimulation can decrease pain localized to one or two regions. Indeed, the electrode placed under the skin helps reduce pain. However, the main complication is the material displacement. In this technical note, we describe a patient with neuropathic pain in his arm resisting to pain treatment. We describe a technique to improve the permanent placement of the electrode leads in the arm. After 1 year, pain is reduced by over 50%.