{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:07:58Z","timestamp":1789150078614,"version":"build-2803163510"},"reference-count":20,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,7,23]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>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\u2019s pretreatment status cannot be determined despite PTSD symptom scores increasing during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2026-108153","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:25:34Z","timestamp":1789147534000},"page":"rapm-2026-108153","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0836-1404","authenticated-orcid":false,"given":"Hesham","family":"Elsharkawy","sequence":"first","affiliation":[{"name":"Anesthesiology, MetroHealth Medical Center, Cleveland, Ohio, USA"},{"name":"Department of Anesthesiology, Physical Medicine, and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"},{"name":"Outcomes Research Consortium, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8849-2850","authenticated-orcid":false,"given":"Amara Breanne","family":"Ajon","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Elsharkawy","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8563-1967","authenticated-orcid":false,"given":"Faria","family":"Nisar","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management, MetroHealth Medical Center, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"2026091110252420000_rapm-2026-108153v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2011.11.009"},{"key":"2026091110252420000_rapm-2026-108153v1.2","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2017.00164","article-title":"Prevalence of Posttraumatic Stress Disorder in Persons with 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activation of Interleukin-6 and interferon-\u03b3 in posttraumatic stress disorder: A double-blind, randomized, sham-controlled trial","volume":"9","author":"Bremner","year":"2020","journal-title":"Brain Behav Immun Health"},{"key":"2026091110252420000_rapm-2026-108153v1.7","doi-asserted-by":"publisher","DOI":"10.1113\/JP282064"},{"key":"2026091110252420000_rapm-2026-108153v1.8","doi-asserted-by":"publisher","DOI":"10.1038\/nature01321"},{"key":"2026091110252420000_rapm-2026-108153v1.9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.neurom.2024.03.002","article-title":"A Mechanistic Analysis of the Neural Modulation of the Inflammatory System Through Vagus Nerve Stimulation: A Systematic Review and Meta-analysis","volume":"28","author":"de Melo","year":"2025","journal-title":"Neuromodulation"},{"key":"2026091110252420000_rapm-2026-108153v1.10","doi-asserted-by":"crossref","DOI":"10.3389\/fnins.2026.1829474","article-title":"Without getting under your skin: non-invasive stimulation activates the vagus nerve","volume":"20","author":"Ingram","year":"2026","journal-title":"Front Neurosci"},{"key":"2026091110252420000_rapm-2026-108153v1.11","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.10.046"},{"key":"2026091110252420000_rapm-2026-108153v1.12","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2017.16010034"},{"key":"2026091110252420000_rapm-2026-108153v1.13","doi-asserted-by":"crossref","first-page":"120483","DOI":"10.1016\/j.jad.2025.120483","article-title":"Long-term efficacy and safety of vagus nerve stimulation in treatment-resistant depression: A systematic review","volume":"394","author":"Rosson","year":"2026","journal-title":"J Affect Disord"},{"key":"2026091110252420000_rapm-2026-108153v1.14","doi-asserted-by":"crossref","first-page":"363","DOI":"10.7326\/M23-2757","article-title":"The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and 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