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Rate ePoster

Pain and Spine Medicine

60-day Peripheral Nerve Stimulation for the Treatment of Cluneal Neuropathy in a Patient with Multiple Sclerosis

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 4

    Poster Presenter(s)

  • Emily Deschler, BS

    Medical Student
    Sidney Kimmel Medical College at Thomas Jefferson University
    Allentown, Pennsylvania

    • Co-Author(s)

  • Samuel T. Dona, Jr., MD

    Assistant Professor
    University of Maryland School of Medicine
    Hunt Valley, Maryland

  • Justin Mendoza, DO

    Attending Physician
    Summit Medical Group
    Fair Lawn, New Jersey

  • JP

    Janus Patel, MD, MPH

    Assistant Professor
    Wake Forest School of Medicine of Wake Forest Baptist Medical Center
    Winston Salem, North Carolina

  • EG

    Enrique Galang, MD

    Assistant Professor
    Wake Forest University School of Medicine
    Raleigh, North Carolina

Disclosure(s):
Emily Deschler, BS: No financial relationships to disclose
Samuel T. Dona, MD, Jr.: No financial relationships to disclose
Justin Mendoza, DO: No financial relationships to disclose
Case Diagnosis: A middle-aged female with cluneal neuropathy in the setting of multiple sclerosis (MS) achieved significant pain relief following 60-day peripheral nerve stimulation (PNS).

Case Description or Program Description: The patient, with a history of MS and chronic musculoskeletal pain, had previously undergone lumbar radiofrequency ablations and sacroiliac joint injections, which alleviated axial low back and sacroiliac joint pain but left persistent pain in the buttock, ilium, and iliac crest. A diagnosis of bilateral cluneal neuropathy (right side predominant) was made based on medical history, physical examination, and imaging to rule out other pathologies. Conservative treatment with gabapentin, tramadol, acetaminophen, and topical pain medications failed to provide adequate relief. Given refractory symptoms, the patient underwent fluoroscopic-guided implantation of a 60-day PNS system targeting the right medial and superior cluneal nerves.

Setting: Academic tertiary interventional pain clinic

Assessment/Results: At 30 and 60 days post-procedure, the patient reported a 90% reduction in pain. Following lead removal, pain in the buttock, ilium, and iliac crest continued to improve, reaching 98% relief at two months post-lead pull. The patient also demonstrated improvements in sleep and activities of daily living.

Discussion (relevance): This case highlights the successful use of a 60-day PNS implant for sustained pain relief and functional improvement in a patient with cluneal neuropathy in the setting of MS. Emerging evidence suggests that autoimmune processes in MS may contribute to peripheral neuropathy, including small fiber dysfunction. While direct evidence on the use of PNS for cluneal neuropathy specifically in MS patients is limited, studies demonstrating success of PNS in treating both MS-related pain syndromes and cluneal neuropathy separately suggest potential efficacy.

Conclusions: MS patients may have an increased risk of peripheral neuropathy. PNS represents a viable treatment option for patients with MS and refractory cluneal neuropathy unresponsive to conservative management and traditional interventional therapies.