Post-operative Carpal Tunnel Release-related pain successfully treated with peripheral nerve stimulation: a Case Report.

Case Diagnosis: Chronic refractory wrist pain following carpal tunnel release, successfully treated with a Peripheral Nerve Stimulator (PNS).

Case Description or Program Description: A 68-year-old man with multiple pathologies, including carpal tunnel syndrome, cervical radiculopathy, mononeuropathy, and post-laminectomy syndrome, experienced persistent wrist pain despite prior interventions such as transcutaneous nerve stimulation, physical therapy, epidural injections, opioids, an intrathecal pump, and spinal cord stimulation (SCS). SCS improved his low back pain but failed to relieve his predominant wrist pain.

A Peripheral Nerve Stimulator (PNS) trial was initiated for his refractory wrist pain and paresthesias, which persisted for years post-carpal tunnel release. Baseline pain was 9/10 on the Numeric Rating Scale (NRS), with stabbing, burning, and tingling sensations in the median nerve distribution. The patient exhibited allodynia and painful hypoesthesia but no motor deficits. After a 10-day trial, pain decreased by more than 50% (4/10), leading to a permanent implant.

Setting: Outpatient pain management clinic.

Assessment/Results: The patient maintained pain relief post-implant without reprogramming. At 12 months, pain control was complete (0/10), with improved quality of life and sleep. The patient expressed willingness to consider Freedom PNS for other pain sites.

Discussion (relevance): Peripheral Nerve Stimulation (PNS) targeting the median nerve offers a minimally invasive alternative for patients with refractory wrist pain, demonstrating sustained pain relief, functional improvement, and enhanced quality of life, especially in cases resistant to traditional interventions.

Conclusions: Median nerve PNS is an effective and well-tolerated treatment for chronic wrist pain unresponsive to conservative therapies. This case highlights its potential as a long-term pain management option, providing significant relief and improving patient outcomes.