Peripheral Nerve Stimulation for Treatment of Trochanteric Bursitis

Peripheral Nerve Stimulation for Treatment of Trochanteric Bursitis 

Author Block: Alexander E. Yakovlev, Comprehensive Pain Management of The Fox Valley, SC, Appleton, WI; Beth E. Resch, APNP, Comprehensive Pain Management of The Fox Valley, SC, Appleton, WI;

Abstract:
Introduction
Greater trochanteric bursitis is a common painful condition often treated in pain clinics. If conservative treatment of rest, splints, heat, and cold application is not beneficial, patients may need more advanced treatments including physical therapy that includes range of motion exercises and splinting, corticosteroid injections, and surgery. Use of peripheral nerve field stimulation may be beneficial to control chronic intractable pain associated with this condition. Peripheral nerve stimulation has been used to treat patients with injuries to a specific nerve, including application to occipital, ilioinguinal, supraorbital, and trigeminal neuralgia. Recently peripheral nerve field stimulation has been utilized to treat patient with postlaminectomy syndromes.

Methods
A 63 year-old female with a history of bilateral greater trochanteric bursitis had previously failed conservative therapies including physical therapy, TENS, opioid and non-opioid pain medications, steroid injections to the greater trochanteric bursa, trigger point injections, botox injections, and finally bilateral greater trochanteric bursectomy. She underwent a successful trial of two 8-electrode percutaneous leads positioned in the subcutaneous tissue in the area of greatest pain, parallel to postoperative scar over the left lateral thigh. During the trial the patient reported >90% improvement in left hip pain. Twelve weeks later the patient underwent implantation of permanent peripheral nerve stimulator leads and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator.

Results
After final implantation the patient reported almost 100% pain relief with permanent stimulator. She was able to decrease use of pain medications and is scheduled for peripheral nerve stimulator trial to cover area of pain over her right hip.
Conclusions: Peripheral nerve field stimulation appears to be effective, safe and less invasive treatment for patients who exhausted traditional treatments for chronic pain related to greater trochanteric bursitis.