Skip to main content
Physiatry '26 Main banner
Final Program


Final Program

Neuromodulation

404 - A Step in the Right Direction: 60-Day Peripheral Nerve Stimulator for the Treatment of Post Herpetic Neuralgia of the Plantar Foot

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Post-Herpetic Neuralgia Pain treated with 60-day Peripheral Nerve Stimulator

Case Description: We present a 55-year-old man with a history of postherpetic neuralgia involving the left lateral thigh, lateral knee, and most prominently the plantar surface of the left foot. His pain was refractory to epidural steroid injections, topical capsaicin patch therapy, and pharmacotherapy. He was managed with gabapentin 600 mg nightly, which offered minimal improvement in symptoms. His primary concern remained chronic neuropathic pain with associated allodynia in the plantar aspect of his foot that significantly interfered with daily function, ambulation, and overall quality of life. 

Discussions: Peripheral nerve stimulation (PNS) offers a promising therapeutic option for patients with refractory postherpetic neuralgia (PHN), particularly when symptoms are localized to a target peripheral nerve. In this case, our patient had plantar foot pain that could be isolated to the posterior tibial nerve confirmed by a diagnostic block that resulted in complete resolution of pain for 8 hours. Prior to implantation, the patient reported severe pain rated 8/10, refractory to multiple conservative measures and requiring nightly gabapentin with partial relief with associated mental fog and grogginess.  We implanted a single-lead 60 day stimulator along the posterior tibial nerve using ultrasound guidance.  During the treatment, pain was reduced dramatically to 1/10. This provided complete discontinuation of gabapentin and improved functional capacity. Once the lead was pulled, the pain relief continued and has remained long lasting.  

Conclusions: Peripheral nerve stimulation (PNS) provides significant benefits for patients with focal neuropathic pain conditions such as postherpetic neuralgia. By directly targeting the affected nerve, PNS modulates pain pathways and reduces abnormal signaling without the systemic side effects of long-term medications. In this case, stimulation of the posterior tibial nerve resulted in a dramatic decrease in pain. Beyond pain reduction, PNS can restore functional mobility, improve sleep, and enhance quality of life.