119 Case Series: Outcomes in Peripheral Nerve Stimulation for Medically Refractory Atypical Facial Pain. Issue Volume 65:Issue CN(2018)Supplement 1 (16th August 2018)

• Record Type: Journal Article
• Authors: McMahon, James T; Tora, Muhibullah S; Bentley, J. Nicole; Campbell, Melissa A; Keifer, Orion P; Boulis, Nicholas M
• Is Part Of: Neurosurgery. Volume 65:Issue CN(2018)Supplement 1
• Page Start: 87
• Page End: 87
• Publication Date: 2018-08-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy303.119
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Peripheral nerve stimulation (PNS) may be an effective treatment for medically refractory atypical facial pain. This study examined subjective pain and visual analog scale (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 who underwent PNS for atypical facial pain. Recorded parameters include affected nerve distributions, subjective pain reduction >50%, pre and postoperative VAS scores, rate of implantation of permanent electrodes, and complications. RESULTS: Fifteen patients were identified with an average age of 55 yr (SD 10), 4 male, 11 female, and an average VAS of 6.3 at initial presentation. Eleven (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). Ten (67%) patients requested and received permanent implants. Six complications occurred (40%) requiring reoperation, including explantation of 3 devices due to the complications. CONCLUSION: PNS may be an effective therapy in patients with atypical facial pain who are refractory to medical treatment. Preliminary data indicate 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.