Ultrasound-guided percutaneous temporary vagus nerve stimulation for refractory post-traumatic chronic pain and post-traumatic stress disorder (PTSD): first reported case and implantation technique.

Abstract

Post-traumatic stress disorder (PTSD) and chronic pain frequently coexist and are often refractory to conventional therapies. Vagus nerve stimulation (VNS) has emerged as a potential neuromodulatory approach targeting autonomic dysregulation and central pain pathways. VNS has traditionally been delivered using either transcutaneous approaches or surgical implantation; however, to the best of our knowledge, ultrasound-guided percutaneous peripheral nerve stimulation targeting the vagus nerve has not previously been described. We present the case of a female in her late 20s with refractory chronic pain syndrome, PTSD, post-traumatic headaches, and occipital neuralgia following multiple traumatic brain injuries sustained during domestic violence. After failing conservative management, the patient underwent ultrasound-guided percutaneous implantation of a left vagus nerve peripheral nerve stimulator for 60 days and demonstrated remarkable improvement. Over an 8-week period of temporary implantation, pain scores decreased from 10/10 to 0/10, with concomitant resolution of gastrointestinal symptoms, fatigue, and PTSD symptoms. Analgesic improvement was sustained at 4-month follow-up, while PTSD symptom scores measured using the PTSD Checklist for DSM-5 (PCL-5) increased during the same time interval. Because a baseline pre-procedure PCL-5 score was not available, the overall magnitude of change relative to the patient's pretreatment status cannot be determined despite PTSD symptom scores increasing during follow-up. We present the use of the 60-day percutaneous temporary implantation of VNS for PTSD and chronic post-traumatic pain, along with a detailed description of the ultrasound-guided implantation technique.