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910 - An atypical case of intercostal neuralgia successfully treated by peripheral nerve stimulation

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

CS

Casey Salandra, DO

Resident Physician
UT Southwestern
DALLAS, Texas, United States

Co-Author(s)

MR

Mia ROBB STAHLER, DO

Resident
University of Texas Southwestern
GRAPEVINE, Texas, United States

Corresponding Author(s)

Chaitanya Konda, DO

Assistant Professor
UT Southwestern
Dallas, Texas, United States

Case Diagnosis: Atypical presentation of intercostal neuralgia

Case Description: A 62-year-old male with a history of splenic infarcts secondary to COVID-19 infection requiring splenectomy presented with left-sided abdominal pain that began post-splenectomy. The p</span>ain was left abdominal tightness with associated spasms, particularly with activity. He had no pain while supine but showed rigidity with any movement. The patient trialed various conservative treatments including physical therapy, methocarbamol, and topical creams without significant relief. An ultrasound-guided left transverse abdominis plane block was attempted, providing partial relief for lower abdominal pain. A left ultrasound-guided erector spinae injection was then attempted with improvement in pain; however, he continued to report a persistent band-like pain in his left upper abdominal quadrant. The patient ultimately underwent permanent T11 nerve root peripheral nerve stimulator placement, achieving 100% pain relief. He has experienced continued pain relief at the 1-year post-procedure follow-up.

Discussions: Intercostal neuralgia generally presents as a constant, radicular type pain. This case describes an atypical presentation of intercostal neuralgia with left-sided rigidity with activity and no rigidity or pain while supine at rest. The success of treatment with peripheral nerve stimulation suggests that the etiology of patient’s pain and rigidity was the T11 nerve root. The exact etiology of intercostal neuralgia is unclear but may be COVID-induced nerve injury or nerve insult as a result of splenectomy. There was no associated surgical scarring at the area of pain to suspect that this was cutaneous nerve injury in abdominal wall.

Conclusions: This case exhibits an atypical presentation of intercostal neuralgia that was successfully treated by peripheral nerve stimulation to the T11 nerve root. Peripheral nerve stimulation is not well documented in the literature as a treatment for intercostal neuralgia, making this case noteworthy. Peripheral nerve stimulation is a feasible long-term treatment for intercostal neuralgia refractory to conservative treatment.