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Case report
peer-reviewed

Bilateral Peripheral Nerve Field Stimulation for Intractable Coccygeal Pain: A Case Study Using Dual Lead Intercommunication



Abstract

Coccygeal pain is a difficult chronic pain problem with mixed response to various treatments. This is a report of a case of coccygeal pain that after failing various conservative and interventional procedures over five years was evaluated with a temporary peripheral sacral fascial lead followed by implantation of bilateral sacral paramedian leads for peripheral nerve field stimulation (PNFS). This resulted in marked pain control and resumption of full activity. The visual analog scale (VAS) pain score improved from eight pre-implant to one after implant and has remained at that level in follow-up. Peripheral nerve field stimulation has been reported for axial chronic back pain, post-laminectomy pain and sacroiliac joint pain either alone or in conjunction with epidural spinal cord stimulation. Both single and parallel leads have been used to provide wider stimulation but differences in location have not been examined. This is the first case report of the use of PNFS for treatment of intractable chronic coccygeal pain. The effectiveness of PNFS was established for this patient by using a prolonged 10-day temporary trial period followed by a 30-day interval without stimulation during which the pain returned to the pre-trial level before proceeding with permanent implantation, it was clear that in this case, PNFS was effective for pain control. Interestingly, the trial and permanent leads were both in the posterior sacral fascia but not in identical positions yet equally effective for pain control. The observation of the effectiveness of different positions may indicate that at least for peripheral field stimulation there may be significant current spread in the fascia. Two and three months after the implant, we examined the effect of different lead settings and the effect of unilateral stimulation compared with bilateral stimulation with and without interlead communication. The patient feedback in this case provides some understanding of the effect of field stimulation with different lead placements. A trial of a deep peripheral fascial lead for sacral and coccygeal field stimulation is a simple option and may be a reasonable approach to consider in the range of treatments for chronic coccygeal pain.



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Case report
peer-reviewed

Bilateral Peripheral Nerve Field Stimulation for Intractable Coccygeal Pain: A Case Study Using Dual Lead Intercommunication


Author Information

Michelle Granville

Miami Neurosurgical Center, University of Miami Hospital

Patrick Brennan

Larkin Hospital, Larkin Community Hospital

Robert E. Jacobson Corresponding Author

Miami Neurosurgical Center, University of Miami Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Bilateral Peripheral Nerve Field Stimulation for Intractable Coccygeal Pain: A Case Study Using Dual Lead Intercommunication


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Case report
peer-reviewed

Bilateral Peripheral Nerve Field Stimulation for Intractable Coccygeal Pain: A Case Study Using Dual Lead Intercommunication

Michelle Granville">Michelle Granville, Patrick Brennan">Patrick Brennan, Robert E. Jacobson">Robert E. Jacobson

  • Author Information
    Michelle Granville

    Miami Neurosurgical Center, University of Miami Hospital

    Patrick Brennan

    Larkin Hospital, Larkin Community Hospital

    Robert E. Jacobson Corresponding Author

    Miami Neurosurgical Center, University of Miami Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: November 09, 2017

    DOI

    10.7759/cureus.1832

    Cite this article as:

    Granville M, Brennan P, Jacobson R E (November 09, 2017) Bilateral Peripheral Nerve Field Stimulation for Intractable Coccygeal Pain: A Case Study Using Dual Lead Intercommunication. Cureus 9(11): e1832. doi:10.7759/cureus.1832

    Publication history

    Received by Cureus: October 27, 2017
    Peer review began: October 31, 2017
    Peer review concluded: November 05, 2017
    Published: November 09, 2017

    Copyright

    © Copyright 2017
    Granville et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Coccygeal pain is a difficult chronic pain problem with mixed response to various treatments. This is a report of a case of coccygeal pain that after failing various conservative and interventional procedures over five years was evaluated with a temporary peripheral sacral fascial lead followed by implantation of bilateral sacral paramedian leads for peripheral nerve field stimulation (PNFS). This resulted in marked pain control and resumption of full activity. The visual analog scale (VAS) pain score improved from eight pre-implant to one after implant and has remained at that level in follow-up. Peripheral nerve field stimulation has been reported for axial chronic back pain, post-laminectomy pain and sacroiliac joint pain either alone or in conjunction with epidural spinal cord stimulation. Both single and parallel leads have been used to provide wider stimulation but differences in location have not been examined. This is the first case report of the use of PNFS for treatment of intractable chronic coccygeal pain. The effectiveness of PNFS was established for this patient by using a prolonged 10-day temporary trial period followed by a 30-day interval without stimulation during which the pain returned to the pre-trial level before proceeding with permanent implantation, it was clear that in this case, PNFS was effective for pain control. Interestingly, the trial and permanent leads were both in the posterior sacral fascia but not in identical positions yet equally effective for pain control. The observation of the effectiveness of different positions may indicate that at least for peripheral field stimulation there may be significant current spread in the fascia. Two and three months after the implant, we examined the effect of different lead settings and the effect of unilateral stimulation compared with bilateral stimulation with and without interlead communication. The patient feedback in this case provides some understanding of the effect of field stimulation with different lead placements. A trial of a deep peripheral fascial lead for sacral and coccygeal field stimulation is a simple option and may be a reasonable approach to consider in the range of treatments for chronic coccygeal pain.



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Michelle Granville, M.D.

Miami Neurosurgical Center, University of Miami Hospital

Patrick Brennan

Larkin Hospital, Larkin Community Hospital

Robert E. Jacobson, M.D.

Miami Neurosurgical Center, University of Miami Hospital

For correspondence:
bmjacobs@bellsouth.net

Michelle Granville, M.D.

Miami Neurosurgical Center, University of Miami Hospital

Patrick Brennan

Larkin Hospital, Larkin Community Hospital

Robert E. Jacobson, M.D.

Miami Neurosurgical Center, University of Miami Hospital

For correspondence:
bmjacobs@bellsouth.net