Ultrasound-guided percutaneous peripheral nerve stimulation for postherpetic neuralgia in the anterior neck region: A case report

Postherpetic neuralgia (PHN) is a common complication of herpes zoster, characterized by persistent neuropathic pain. The underlying pathophysiology involves peripheral processes such as abnormal nociceptor activation that lowers pain thresholds, as well as central mechanisms including sensitization in the dorsal horn. Treatment strategies often target neuromodulation at central or peripheral levels. Central approaches such as spinal cord stimulation (SCS) have been applied but carry substantial risks in areas innervated by cervical nerves. In contrast, peripheral nerve stimulation (PNS) offers a safer and more effective option in these regions. The percutaneous approach to PNS is associated with fewer complications and less technical complexity than SCS, and the use of ultrasound guidance further improves accuracy by allowing real-time visualization of neural and vascular structures, thereby reducing procedural trauma and enhancing safety. We describe a patient with PHN involving the anterior neck region who was treated successfully with ultrasound-guided percutaneous PNS. The procedure resulted in significant pain relief and functional improvement, supporting its therapeutic potential for neuropathic pain in this anatomically complex area. This case provides clinical evidence that ultrasound-guided percutaneous PNS is a feasible, safe, and effective intervention for PHN involving cervical nerve distributions. These findings support broader consideration of this technique for managing refractory neuropathic pain.