Treatment of Intractable Headaches Associated with Lyme Disease Using Neuromodulation Techniques
Alexander E.Yakovlev, Comprehensive Pain Management ofThe Fox Valley, SC, Appleton,Wis.
Beth E. Resch, APNP, Comprehensive Pain Management ofThe Fox Valley, SC, Appleton,Wis.
INTRODUCTION
Lyme disease is a bacterial infection caused by Borrelia burgdoferi, which may affect various body systems including the nervous system. Control of headaches associated with lyme disease is difficult to achieve despite multiple treatment modalities. Peripheral nerve stimulation (PNS) has been used to treat patients with injuries to a specific nerve [1], including application to occipital [2], supraorbital and trigeminal neuralgia [3]. Recently this type of treatment is utilized to control different headaches.
METHOD
Four patients with intractable headaches underwent PNS placement. They were diagnosed with Lyme disease, failed conservative therapy and multiple nerve blocks. One of them was male and three were females ages 23 to 35.They underwent successful trial of percutaneous placement of 8-electrode leads in occipital or supraorbital regions. Two weeks later the patients underwent subdermal implantation with permanent leads and non-rechargeable or rechargeable generators.
RESULTS
After implantation the patients reported significant relief of headaches (>60% reduction in VAS). They were able to decrease or discontinue use of pain medications. They also reported other positive outcomes including the ability to return to social and occupational activities and improved family relationships. At 12 months post-implant, the patients continued to report good pain control and improved functional status.
CONCLUSIONS
PNS appears to be a therapeutic alternative for patients with intractable headaches who in the past exhausted all available treatments. This technique is easy to perform, effective, and safe procedure. The therapy is reversible should patients lose its pain-alleviating effect or headaches resolve.
FIGURES
FIGURE 1
REFERENCES
1. Novak CB, Mackinnon SE. Outcome following implantation of a peripheral nerve stimulator in patients with chronic nerve pain. Plast Reconstr Surg 2000; 105:1967-1972.
2. Slavin KV, Nersesyan H,Wess C. Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery 2006; 58:112-119.
3. Johnson MD, Burchiel KJ. Peripheral stimulation for treatment of trigeminal postherpetic neuralgia and trigeminal posttraumatic neuropathic pain: a pilot study. Neurosurgery 2004; 55:135-141.
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