Successful Treatment of Refractory Neuropathic Pain Following Axillary Dissection and Lipoma Resection Using Cervical...

Neuropathy is a pain condition that is caused by an insult to the somatosensory system. Providing adequate management of neuropathic pain (NP) conditions can be challenging as the dis-ease may become progressively nonresponsive to conventional therapies. If conventional treatment options prove ineffective, cervical dorsal root ganglion (DRG) stimulation is a relatively effective, off-label-use therapy for NP, which requires expert cervical placement to be completed safely and effectively. The Neuromodulation Appropriateness Consensus Committee guidelines highlight safety features and general indications for DRG stimulation, which includes current on-label usage up to T10. Although this committee's expert opinions stated that DRG is safe up to the C5 level, there is limited published efficacy and safety data at levels higher than T10.

A 36-year-old woman with a significant medical history of anxiety developed intractable right upper extremity NP following an axillary dissection for a lipoma excision. De-spite conservative management, she presented with debilitating NP and severe right upper ex-tremity functional restrictions following the procedure. The patient underwent a C8-T1 DRG stimulation trial, which decreased her pain levels over 50%, and significantly increased her functional abilities. Right-sided C8-T1 permanent DRG leads were placed, which resulted in improved sleep, increased ability to use her right upper extremity, a 95% to 97% reduction in pain, and elimination of regularly scheduled analgesic medications.

Cervical and high thoracic DRG was safe and successful in the treatment of right upper extremity NP in the upper dermatomal levels secondary to axillary dissection and lipoma resection.