Peripheral Nerve Stimulation for Treatment of Intractable Neuropathic Facial Pain

Peripheral Nerve Stimulation for Treatment of Intractable Neuropathic Facial Pain

Sergey Karasev, MD Alexander E. Yakovlev, MD, Comprehensive Pain Management of The Fox Valley, SC, Appleton, Wisconsin, USA

INTRODUCTION
The treatment of patients with neuropathic facial pain developed after facial surgery or trauma can be difficult. Control of pain can be challenging to achieve, despite multiple treatment modalities available in the field of pain management. Medical treatment is often ineffective and wrought with intolerable side effects. Surgical approaches are not reliable. Peripheral nerve stimulation (PNS) has been used to treat a variety of neuropathies, including supraorbital, ilioinguinal, occipital, post-herpetic, and trigeminal with excellent relief of pain. Management of neuropathic facial pain using PNS can be an effective modality.

MATERIALS AND METHODS
Six patients suffering from intractable neuropathic facial pain underwent PNS placement. One of them was male and five were females aged from 22 to 74. The patients failed conservative therapy and received no pain relief after different nerve blocks.
The patients underwent a successful two day trial of percutaneous placement of one or two 8-electrode leads. The leads were placed in mandibular, infraorbital or supraorbital areas. Two weeks later the patients underwent implantation with permanent leads placed subdermally and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generators.

RESULTS
At 12 months post-implant, the patients continued to report good pain control and improved functional status. All patients were able to decrease or discontinue use of pain medications.

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CONCLUSION
PNS may be a safe, effective, and reversible technique for patients with neuropathic facial pain; who in the past exhausted all available treatments. PNS is an important adjuvant treatment which may make its own niche in the therapy algorithm for this group of patients.