A novel single-lead percutaneous approach for multi-nerve peripheral stimulation in upper extremity pain: A case report

Abstract

Peripheral nerve stimulation (PNS) is an emerging modality for managing painful peripheral neuropathy, offering potential long-term relief when conservative treatments fall short. Conventionally, each PNS lead targets a single nerve, necessitating multiple leads in cases involving pain across multiple nerve distributions. This case report presents a novel approach using a single PNS lead to target multiple peripheral nerves in the upper extremity via an axillary brachial plexus approach. We describe a 47-year-old female with a three-year history of intractable neuropathic pain localized to the ulnar and median nerve distributions, who underwent a temporary PNS trial after failing conventional therapies, including physical therapy, medications, and corticosteroid injections. Under ultrasound guidance, a single PNS lead was placed at the brachial plexus, targeting both ulnar and median nerves. Optimal stimulation thresholds were achieved, and the patient reported 80–100% pain relief throughout the 60-day trial period, with sustained relief for six months post-lead removal. This approach leverages the anatomical proximity of the ulnar, median, and radial nerves at the axilla, enabling multi-nerve targeting with a single lead. The technique offers potential advantages, including reduced procedural complexity, fewer risks, and cost savings, especially in the current landscape of increasing insurance denials for neuromodulation procedures.