Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Pain Physician. 2016 Mar;19(3):E459-63.
Brachial plexopathy usually results from an iatrogenic brachial plexus injury and can sometimes cause severe chronic pain and disability. There are a number of possible treatments for this condition, including medication, physical therapy, nerve blocks, and neuromodulation, but they are not always successful. Recently, combined spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been tried for various chronic pain diseases because of their different mechanisms of action.Here, we describe the case of a 54-year-old man who was diagnosed with brachial plexopathy 8 years ago. He underwent video-assisted thoracoscopic surgery to remove a superior mediastinal mass. However, his brachial plexus was damaged during the surgery. Although he had received various treatments, the pain did not improve. For the management of intractable severe pain, he underwent SCS 2 years ago, which initially reduced his pain from numeric rating scale (NRS) 10/10 to NRS 4 - 5/10, but the pain then gradually increased, reaching NRS 8/10, 6 months ago. At that time, he was refractory to other treatments, and we therefore applied PNS in combination with SCS. The PNS electrode was positioned on the radial nerve under ultrasound guidance. After combined PNS and SCS, his background pain disappeared, although a breakthrough pain (NRS 3 - 4/10) was caused intermittently by light touch. Furthermore, the patient's need for analgesics decreased, and he was satisfied with the outcome of this combined treatment. We concluded that combined SCS and PNS is a very useful treatment modality, which can stimulate the target nerve both directly and indirectly, and hence, relieve pain from brachial plexopathy.
臂丛神经病通常是由医源性臂丛神经损伤引起的，有时会导致严重的慢性疼痛和残疾。对于这种疾病有许多可能的治疗方法，包括药物治疗、物理治疗、神经阻滞和神经调节，但并不总是有效。最近，由于作用机制不同，联合脊髓刺激（SCS）和周围神经刺激（PNS）已被尝试用于治疗各种慢性疼痛疾病。在这里，我们描述了一名 54 岁男性的病例，他 8 年前被诊断为臂丛神经病。他接受了电视辅助胸腔镜手术以切除纵隔肿块。然而，他的臂丛神经在手术中受损。尽管他接受了各种治疗，但疼痛并未改善。为了治疗难治性严重疼痛，他在 2 年前接受了 SCS，最初将他的疼痛从数字评分量表（NRS）的 10/10 降至 NRS 4-5/10，但随后疼痛逐渐加重，6 个月前达到 NRS 8/10。当时，他对其他治疗方法无反应，因此我们采用了 PNS 与 SCS 联合应用。在超声引导下，将 PNS 电极放置在桡神经上。在联合 PNS 和 SCS 后，他的背景疼痛消失了，尽管间歇性轻触会引起爆发性疼痛（NRS 3-4/10）。此外，患者对镇痛药的需求减少了，他对这种联合治疗的效果非常满意。我们得出结论，联合 SCS 和 PNS 是一种非常有用的治疗方式，它可以直接和间接刺激目标神经，从而缓解臂丛神经病引起的疼痛。
