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  • Case Series: Outcomes in Peripheral Nerve Stimulation for Medically Refractory Atypical Facial Pain

    Final Number:

    James Tanner McMahon BS; Muhibullah S Tora BS; J. Nicole Bentley MD; Melissa A Campbell NP; Orion P Keifer MD, PhD; Nicholas M. Boulis MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Peripheral nerve stimulation (PNS) may be an effective treatment for medically refractory atypical facial pain. This study examined subjective pain and VAS scores before and after the use of neuromodulatory devices on the trigeminal and occipital nerves.

    Methods: Retrospective chart review was performed for adult patients presenting to Emory University Hospital that underwent PNS for atypical facial pain. Recorded parameters include: affected nerve distributions, subjective pain reduction >50%, pre and post-operative VAS scores, rate of implantation of permanent electrodes, and complications.

    Results: 15 patients were identified with an average age of 55 years (SD 10), 4 male, 11 female, and an average VAS of 6.3 at initial presentation. 11 (73%) patients reported pain in a V1 trigeminal distribution, 12 (80%) in V2, 6 (40%) in V3, and 2 (13%) in an occipital distribution. Of the 15 patients who received a trial stimulation period, 12 (80%) endorsed a subjective improvement in their pain of >50%, with a mean reduction in VAS score of 5.3 (SD 2). 10 (67%) patients requested and received permanent implants. 6 complications occurred (40%) requiring reoperation, including explantation of 3 devices due to the complications.

    Conclusions: PNS may be an effective therapy in patients with atypical facial pain who are refractory to medical treatment. Preliminary data indicates that targeted stimulation to branches of the trigeminal and occipital nerves can decrease subjective pain. Further exploration is required to determine the longevity of this therapy, changes in narcotic dependence, and comparison to other surgical and pharmaceutical strategies.

    Patient Care: Neuromodulation is a novel treatment for medically refractory atypical facial pain that has the potential to provide relief for patients suffering from a debilitating condition. Our preliminary data shows that this treatment may be effective and opens the door for neurosurgeons across the country to potentially use method this to help treat their patients.

    Learning Objectives: 1. Identify situations in which a patient with atypical facial pain may benefit from a peripheral nerve stimulation trial. 2. State preliminary data regarding the efficacy and possible complications of this treatment


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