Overview
Intercostal peripheral nerve stimulation (PNS) delivers targeted electrical stimulation to the intercostal nerves — the nerves running along the undersurface of each rib — to treat chronic chest wall neuropathic pain. Post-mastectomy pain syndrome and post-thoracotomy pain syndrome are among the most common and debilitating causes of chronic chest wall pain, affecting an estimated 20–50% of patients after breast surgery and up to 50% after thoracic surgery. These conditions are caused by injury to the intercostal nerves during surgical procedures and can produce severe, persistent neuropathic pain that significantly impacts quality of life. Dr. Migdale has specific research and clinical interest in intercostal PNS for these conditions, with an accepted abstract at ASRA 2025.
Post-Mastectomy Pain Syndrome
Post-mastectomy pain syndrome (PMPS) is a recognized chronic pain condition that develops after breast surgery — including mastectomy, lumpectomy, and axillary lymph node dissection. It is characterized by chronic aching, burning, or shooting pain in the chest wall, axilla, and inner arm, often accompanied by allodynia (sensitivity to light touch) and dysesthesia (abnormal sensations). The pain arises from injury to the intercostal brachial nerve and other chest wall nerves during surgery.
Post-Thoracotomy Pain Syndrome
Post-thoracotomy pain syndrome (PTPS) occurs after thoracic surgery — including lung resection, esophageal surgery, and cardiac surgery via thoracotomy. The intercostal nerves are particularly vulnerable to injury during rib spreading, which can produce severe intercostal neuralgia that persists indefinitely. PTPS is one of the strongest predictors of long-term post-surgical pain and opioid use after thoracic surgery.
Research: Dr. Migdale's ASRA Abstract
Dr. Migdale's accepted abstract at the ASRA Pain Medicine 24th Annual Meeting (Austin, TX, November 2025) describes a challenging case of combined post-mastectomy and post-thoracotomy neuralgia successfully treated with intercostal peripheral nerve stimulation. This case highlights both the clinical utility of PNS for chest wall pain and the technical feasibility of intercostal nerve targeting with percutaneous leads.