405 - 60-Day Percutaneous Peripheral Nerve Stimulation for Chronic Radiculopathy may Provide Long-Term Pain Relief with Intermittent Treatment when Traditional Approaches are Ineffective: A Case Report

A 65 year-old female presents with 6 months of 8/10 anterior thigh pain that radiates to the calf.

Case Description: The patient initially began physical therapy and was prescribed Gabapentin, titrated up to 300 mg three times daily. After five months, pain was reduced to 4/10. Subsequently, the patient received an L3/L4 transforaminal epidural steroid injection (ESI) on her left side, which resulted in a 70% improvement in pain for three months. However, a repeat ESI provided only minimal relief. Following this, a temporary left sciatic peripheral nerve stimulator (PNS) was implanted with a stimulation setting of 50, leading to a 75% reduction in her left leg pain. Two months later, the PNS lead was removed, yet she continued to report sustained pain relief during a one-year follow-up. Duloxetine 20 mg was introduced to manage lingering pain, but after three months, the pain began to slowly return to baseline. The patient is set to undergo another temporary PNS implantation.

Discussions: Sciatica has a lifetime incidence ranging from 10% to 40%. While temporary PNS has shown benefits in certain patients after lead removal, there is limited data available on pain relief at the one-year mark. This case highlights the potential of intermittent PNS as a viable alternative for patients who have not experienced sufficient relief from conventional interventional and conservative treatments.

Conclusions: Temporary PNS may offer an effective solution for managing chronic sciatic pain, particularly in cases where traditional therapies have failed. Its intermittent use may provide long-term relief without the need for a permanent implant. However, further research is essential to fully explore the long-term benefits and potential of temporary PNS in chronic pain management.