Peripheral subcutaneous neurostimulation in the management of neuropathic pain: five case reports

Introduction.  Spinal cord stimulation (SCS) is an effective treatment option for neuropathic pain. However, because of the obvious procedural issues, SCS is unable to reach certain areas, such as the face, thorax, coccyx, the cervico-dorsal and lumbar areas, and the sacral, abdominal, and inguinal regions. On the other hand, these areas are easily reached by subcutaneous field stimulation. Methodology.  We report the analgesic results, using a visual analog scale (VAS), of five patients with neuropathic pain treated with subcutaneous field stimulation to the area. We also discuss the probable mechanism of action, and highlight the technical issues inherent to this approach. Results.  Significant pain reduction and reduction in analgesic medication were reported in all patients during the study period, with VAS scores consistently lowered by more than 50% from baseline levels. As a result of pain reduction, the patients' quality of life improved. There were no adverse events reported except for early electrode array displacement in two of our patients. Conclusion.  When SCS is not appropriate for certain neuropathic pain syndromes, subcutaneous field stimulation may be used with some degree of efficacy.