An ultrasound-guided percutaneous method of vagal nerve stimulation may be effective for refractory chronic pain

1. This case demonstrates the first reported use of ultrasound-guided percutaneous peripheral nerve stimulation of the vagus nerve, achieving durable, complete resolution of refractory chronic pain.

Evidence Rating Level: 3 (Average) 

PTSD and chronic pain commonly co-occur and are frequently resistant to standard treatment approaches. Vagus nerve stimulation (VNS) has gained interest as a neuromodulatory strategy for addressing autonomic dysregulation and central pain processing, but it has typically been delivered via transcutaneous or surgically implanted systems; ultrasound-guided percutaneous peripheral nerve stimulation of the vagus nerve had not been previously reported. This case report describes a woman in her late twenties with refractory chronic pain, PTSD, post-traumatic headaches, and occipital neuralgia stemming from multiple traumatic brain injuries sustained during domestic violence. After conservative management failed, she underwent ultrasound-guided percutaneous implantation of a left-sided vagus nerve peripheral nerve stimulator for a 60-day trial period. Over 8 weeks, her pain scores improved from 10/10 to 0/10, accompanied by resolution of gastrointestinal symptoms and fatigue, with analgesic benefit maintained at 4-month follow-up. PTSD symptoms, measured by the PCL-5, appeared to worsen over the same interval; however, the absence of a baseline pre-procedure score precludes determining the true magnitude of change from pretreatment status. The authors detail their ultrasound-guided implantation technique alongside this novel application.

Click here to read this study in Regional Anesthesia & Pain Medicine

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