ABSTRACT
Introduction: Peripheral nerve stimulation (PNS) is an emerging modality for treatment of chronic pain. We describe the positive outcome with PNS of a patient whose surgical intervention for severe bilateral glenohumeral osteoarthritis was delayed to COVID-19 restrictions. Materials / Methods: 66 year-old male with severe bilateral glenohumeral osteoarthritis needed bilateral total shoulder arthroplasty however surgical intervention was delayed for months by COVID-19 restrictions. Conservative therapies including physical therapy, intra-articular injections, and oral opioids had previously failed thus we offered PNS. Placement of the right suprascapular PNS system was followed 2 weeks later by left suprascapular PNS system placement. The systems were placed without complication under ultrasound guidance with leads overlying the suprascapular nerves inferior to the suprascapular notch. [Formula presented] Results: At 2 weeks right shoulder pain was reduced by 60% while left shoulder pain was reduced by 70%. His pain decreased by 90% at 4 weeks. Most remarkably he noted significant increases in quality of life and improved independence in daily activities. Discussion(s): Osteoarthritis (OA) is a common cause of joint pain and dysfunction, a result of progressive mechanical and biochemical joint degeneration. OA results in a U.S. economic burden of $130 billion annually(1) with shoulder OA affecting over 30% of U.S. adults over 60 years old(2). COVID-19 delays in surgical cases, as with our patient, extends nationwide with a projected backlog of 1 million total joint and spine cases by 2022(3). Peripheral nerve stimulation originates from the gate control theory noted in 1965. PNS works through activation of large diameter fibers that attenuate nociceptive signaling in the dorsal horn. Through stimulation of afferent fibers, peripherally-induced plasticity can reverse central features of chronic pain. PNS is used in treatment of an expanding multitude of conditions such as peripheral neuralgia and complex regional pain syndrome. PNS involves targeting specific nerve trunks with electrical stimulation, providing directed therapy with a less invasive approach. Pain relief is expected to last beyond treatment duration and in a majority of cases lasts for one year or more. Studies of percutaneous PNS systems propose the prolonged relief following interim treatment periods results from a widened therapeutic window. Selective activation of Aalpha and Abeta fibers generate comfortable sensations in the painful area initiating a cascade of analgesic mechanisms from the periphery to the dorsal horn and cortex. Conclusion(s): An increasing number of studies continue to show significant pain relief with use of PNS(3)(4) providing an exciting opportunity for patients who fail conservative therapies. Learning Objectives: 1.) Highlight the use of emerging pain treatment modalities while navigating healthcare systems affected by COVID-19 2.) Highlight the use of peripheral nerve stimulation (PNS) for chronic pain syndromes typically treated surgically 3.) Showcase the quality of pain relief achieved by less invasive, interim treatments such as peripheral nerve stimulation (PNS). Keywords: peripheral nerve stimulation Copyright © 2022