Dr Michael Vagg of Pain Matrix in Geelong, presented 3 PENS cases at the INS meeting in Perth today.
Case Report 1
A 62 year old primary school teacher with arthroscopic meniscal debridement with port site neuroma. Poor pacer but otherwise a resourceful self-manager. Her previously failed treatments included anti-neuropathics, Thermal and Pulsed RF and Versatis patches. Her first PENS treatment gave 100% pain relief for 3 weeks and her last treatment gave 100% relief for 92 days.
Case Report 2
A 25 year old aspiring paramedic who suffered a compound right ankle fracture, which left her with an area of defined allodynia and hyperalgesia below the lateral malleolus. She was unable to wear boots and was struggling to continue working as EN on the paediatric ward. She got 3-4 months benefit from lignocaine infusions but did not want to continue this indefinitely. Anti-neuropathic medications were ineffective or too sedating. She had a single PENS treatment which gave 100% pain relief and was subsequently accepted into Ambulance Victoria.
Case Report 3
A 44 year old former nursing lecturer with OCD/BAD and chronic low back pain which was initially clearly episodic and discogenic, but in the last 2 years has been more diffuse and constant. She uses variable but often high doses of opioids and anti-neuropathic drugs in conjunction with her psychiatric medications. Regular ketamine infusions help with dose containment. She had PENS to the lumbar region twice, which gave her 80% reduction in diffuse back pain, with containment reduction in opioid use and distress.
PENS is a minimally invasive diagnostic therapy, which enables the physician to determine whether a patient is likely to benefit from an implanted stimulation device, although for some patients it may also provide ongoing pain management, thereby avoiding the need for more invasive therapies, with their attendant risks. There are also patients for whom an implanted device is not appropriate and in these cases PENS therapy offers an alternative where other less invasive or pharmacological modalities have failed.