Intercostal Neuralgia Successfully Managed With Peripheral Nerve Stimulation

Intercostal neuralgia is characterized by neuropathic pain along the distribution of the intercostal nerve, which can cause debilitating pain and interfere with daily activities. The literature is extremely limited in assessing the use of neuromodulation to treat trauma-induced intercostal neuralgia. This case reports a 40-year-old patient who presented with decades of refractory, long-standing thoracic pain. The pain ranged from a four out of 10 to a nine out of 10 on the numeric rating scale (NRS). The patient failed pharmacologic therapy, physical therapy, chiropractic care, injection therapy, transcutaneous electrical nerve stimulation (TENS), and spinal cord stimulation (SCS). The patient underwent a 60-day peripheral nerve stimulation (PNS) trial, which temporarily relieved the pain until it was explanted. The patient subsequently underwent placement of a permanent PNS implant, which provided between 80-100% daily pain relief at a six-month follow-up. At the two-year follow-up, the patient continued to experience sustained pain relief, had weaned from opioid medications, and returned to all desired daily activities. This case suggests that minimally invasive PNS can effectively manage pain for patients with intercostal neuralgia who fail conservative measures. Further, to our knowledge, this two-year follow-up is the longest-reported outcome in the literature for using PNS for intercostal neuralgia after traumatic injury.