Percutaneous brachial plexus peripheral nerve stimulation for cancer-related upper extremity pain: a novel technical approach

Background Peripheral nerve stimulation (PNS) is a well-established therapy for neuropathic pain syndromes. Emerging literature suggests that PNS is effective for treating oncologic pain. Objective This case report presents a novel ultrasound-guided, dual-lead PNS neuromodulation of the brachial plexus for upper-extremity cancer pain, with a focus on technical considerations. Methods Temporary, percutaneous, brachial plexus PNS was implanted in a patient with metastatic lung adenocarcinoma who was hospitalized for refractory pain from a pathologic humeral fracture. A novel approach is presented via the DAVIS (Dual-Lead Approach with Vectoring in the Subclavicular Plane) technique. This technique uses a parallel, subclavicular trajectory to optimize parallel lead positioning and minimize migration. Nerve localization, procedural technique, and patient-specific considerations are discussed. Results Following PNS implantation, the patient achieved complete cessation of opioid use with substantial and sustained pain relief, highlighting the clinical potential of the DAVIS technique. Conclusion Brachial plexus PNS presents a promising strategy for extremity oncologic pain. Novel approaches focusing on dual-lead placement with a parallel trajectory may expand the efficacy of PNS in anatomically complex or opioid-refractory cases.