1342 - A Prospective Case Series of PNS Treatment for Cluneal Neuralgia

Objectives: Peripheral nerve stimulation (PNS) is a minimally invasive neuromodulatory therapy that delivers targeted electrical stimulation to peripheral nerves to alleviate chronic pain. Cluneal neuralgia, a neuropathic pain condition affecting the cluneal nerves of the lower back and buttock, often proves refractory to conservative measures. PNS has emerged as a promising intervention, but clinical evidence remains limited.

Design: We conducted a prospective analysis of 30 patients with cluneal neuralgia who underwent 60-day PNS implantation. Demographic and clinical variables including age, sex, BMI, years of pain, depression, anxiety, use of anxiolytics or insomnia medications, opioid use, and history of surgery were collected. Outcomes were assessed using the Oswestry Disability Index (ODI), Numerical Rating Scale (NRS) for pain, and disability scores before and after treatment. Paired t tests compared baseline and post-implant outcomes, with effect sizes reported as Cohen’s d. Linear regression models evaluated associations between covariates and treatment response.

Results: Thirty patients completed follow-up. Mean ODI decreased from 30.97 ± 7.21 to 15.80 ± 7.82 (t(29)=12.25, p< 0.0001, Cohen’s d=2.24). Mean NRS scores decreased from 7.77 ± 1.22 to 4.40 ± 1.77 (t(29)=10.41, p< 0.0001, d=1.90). Baseline disability scores declined from 61.93 ± 14.43 to 31.60 ± 15.65 (t(29)=12.25, p< 0.0001, d=2.24). Age, sex, BMI, years of pain, depression, opioid use, and prior surgery were not significantly associated with post-PNS ODI or disability ratings (p >0.2). Male sex, however, was associated with lower post-treatment NRS scores (β=-2.33, p=0.023).

Conclusions: PNS resulted in significant reductions in pain and disability among patients with cluneal neuralgia, with large effect sizes across outcomes. These findings support PNS as an effective treatment option for refractory neuropathic pain and highlight the need for further investigation in other peripheral nerve entrapments and injury-related syndromes.