Neuromodulation Techniques for Atypical Facial Pain
INTRODUCTION
Atypical facial pain (ATFP) represents a wide group of facial pain problems with common symptoms but a variety of different causes. These include low-grade infectious and inflammatory process, dental or physical trauma, malignant neoplasms involving the base of skull and traumatizing branches of the trigeminal nerve. Even benign tumors of the trigeminal nerve or meninges. These can result in nerve damage and be the triggering factor for ATFP pain. In some of the patients no etiologic factors can be found; patients in this group tend to have significant psychopathology. ATFP differs from trigeminal neuralgia(TN) in every respect.
Successful treatment of the patients with ATFP is challenging and there are few proven therapies available. Peripheral nerve stimulation (PNS) has been used to treat a variety of neuropathies (1), including ileoinguinal , occipital, post-herpetic (2), and stimulation of trigeminal branches was reported for treatment of trigeminal postherpetic neuralgia and trigeminal post traumatic neuropathic pain(3) with excellent relief of pain. Management of ATFP using PNS can be effective modality.
MATERIALS AND METHODS
Nine patients suffering from intractable atypical facial pain underwent PNS placement. Three of them were male and six were females aged from 21 to 74. The patients failed conservative therapy and interventional procedures. The patients underwent successful two days trial of percutaneous placement of one or two 8-electrode leads placed in mandibular, maxillary, temporal, infraorbital or supraorbital areas. Two weeks later the patients underwent implantation with permanent leads placed subdermally (Figure 1) and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator (Figure 2).
RESULTS
At 12 months post-implant, the patients continued to report significant improvement in pain (>50% improvement in VAS) and improved functional status. All patients were able to decrease or discontinue use of pain medications.
FIGURES
F i g u r e 1 F i g u r e 2
CONCLUSIONS
PNS is a safe, effective and reversible technique for patients with ATFP 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.
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. Yakovlev A, Peterson A. Peripheral nerve stimulation in treatment of intractable postherpetic neuralgia- a case report. Neuromodulation 2007; 10:373-375.
3. Dunteman E. Peripheral nerve stimulation for unremitting opthalmic postherpetic neuralgia. Neuromodulation 2002; 5:32-37.
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