Introduction: Facial pain is a complex disease with multiple etiologies including trigeminal neuralgia, post herpetic neuralgia, post- traumatic and neuropathic pain and atypical facial pain as well as other referred pains. Management is initially medical and in most cases is sufficient. Yet there are cases that are resistant to therapy and can significantly affect the patient’s quality of life requiring alternative therapies. We evaluate our experience of applying peripheral nerve stimulation for treatment of facial pain.
Methods: Peripheral neurostimulation was achieved using subcutaneously implanted electrodes either in a supraorbital or infraorbital location, or both. Using the visual analog scale (VAS), we report the results of 9 patients with facial pain due to idiopathic trigeminal neuralgia, trauma, or post herpetic neuralgia both in terms of pain relief and analgesic usage with an average follow-up of 6 months.
Results: Of the 9 patients, 6 had significant reduction in facial pain after a trial of neurostimulation and subsequently underwent permanent lead implantation. . Five of those 6 patients had reduction of facial pain with subjective improvement in quality of life, reduction of chronic pain medication use, and an average reduction in VAS score by 5 ± 1 points, while one patient had no pain reduction. Complications occurred in one patient who had lead erosion requiring removal of the permanent leads 7 month postoperatively, and subsequent reimplatation of the device once infection was cleared. Three patients—one with post herpetic neuralgia, one with post traumatic neuropathy, and the final with post neuropathic trigeminal pain—failed the trial phase.
Conclusions: In properly selected patients, peripheral neurostimulation is effective for facial pain relief in terms of achieving overall improvement in patients’ reported quality of life, decreased dependence on analgesics, and reduction in VAS scores.
Patient Care: evaluating anotehr therapeutic alternative for facial pain
Learning Objectives: evaluate results of applying peripheral nerve stimulation for treatment of trigeminal facial pain