Sham surgery as an alternative procedure for unexplained pain following transvenous implantable cardioverter defibrillator implantation: case report.

BACKGROUND

Persistent pain after implantable cardioverter-defibrillator (ICD) implantation is uncommon and often unexplained after ruling out device-related or musculoskeletal causes. Psychological factors can contribute to symptom persistence, complicating treatment. In rare cases, sham surgery has been considered to address psychogenic pain. This report explores its role in managing atypical post-ICD implantation pain.

CASE SUMMARY: A 76-year-old female with hypertrophic cardiomyopathy, atrial fibrillation, and a history of ICD implantation presented with persistent left parasternal pain radiating to the arm and back. Extensive evaluations ruled out device-related complications, musculoskeletal issues, and nerve injury. Psychological assessment suggested a psychogenic origin, likely reinforced by social factors. After ethics approval, sham surgery was performed, leading to complete symptom resolution and improved quality of life. This case highlights the potential role of psychological interventions in managing medically unexplained post-ICD implantation pain.

DISCUSSION: Post-ICD implantation pain ranges from routine discomfort to complications requiring intervention. Causes include device migration, musculoskeletal issues, nerve damage, infections, and psychological factors. Thorough evaluation is essential to rule out organic causes. Management includes non-steroidal anti-inflammatory drugs, physical therapy, neuropathic pain medications, and psychological support. This case highlights the role of psychogenic factors in persistent pain.