Brachial plexopathy usually results from an iatrogenic brachial plexus injury and can sometimes
cause severe chronic pain and disability. There are a number of possible treatments for this
condition, including medication, physical therapy, nerve blocks, and neuromodulation, but they
are not always successful. Recently, combined spinal cord stimulation (SCS) and peripheral
nerve stimulation (PNS) have been tried for various chronic pain diseases because of their
different mechanisms of action.
Here, we describe the case of a 54-year-old man who was diagnosed with brachial plexopathy 8
years ago. He underwent video-assisted thoracoscopic surgery to remove a superior mediastinal
mass. However, his brachial plexus was damaged during the surgery. Although he had received
various treatments, the pain did not improve. For the management of intractable severe pain,
he underwent SCS 2 years ago, which initially reduced his pain from numeric rating scale
(NRS) 10/10 to NRS 4 – 5/10, but the pain then gradually increased, reaching NRS 8/10, 6
months ago. At that time, he was refractory to other treatments, and we therefore applied
PNS in combination with SCS. The PNS electrode was positioned on the radial nerve under
ultrasound guidance. After combined PNS and SCS, his background pain disappeared, although
a breakthrough pain (NRS 3 – 4/10) was caused intermittently by light touch. Furthermore,
the patient’s need for analgesics decreased, and he was satisfied with the outcome of this
combined treatment.
We concluded that combined SCS and PNS is a very useful treatment modality, which can
stimulate the target nerve both directly and indirectly, and hence, relieve pain from brachial
plexopathy.
Key words: Brachial plexopathy, spinal cord, peripheral nerve, stimulation, ultrasound,
neuropathic
Combined Spinal Cord Stimulation and
Peripheral Nerve Stimulation for Brachial
Plexopathy: A Case Report
