137 Successful Management of Refractory Craniofacial Pain With Peripheral Nerve Field Stimulation: An International Case Series

Abstract

INTRODUCTION: Craniofacial pain syndromes (CPS) encompass various debilitating pain etiologies including trigeminal neuralgia, migraine, cluster headaches, atypical facial pain and post-herpetic neuralgia. Although medical management is initially indicated, most patients with CPS eventually require surgical intervention. METHODS: This is a retrospective chart review of adults with refractory CPS who underwent PNFS. Implantation areas included the greater occipital nerve and CNV branches. Outcomes include pain severity measured with Barrow Pain Scale (BPS), functional status pre- and post-operatively, complications secondary to PNFS, and time to re-intervention. RESULTS: Seventeen patients underwent PNFS implantation for: atypical TN (48%), migraine (18%), post-herpetic neuralgia (12%), other CPS (17%). Baseline BPS pain score was 5/5 for all patients. At 2 weeks post-PNFS 88% of patients (N = 16) reported BPS score of 1/5. At 1-month post-PNFS 77% of patients (N = 17) had BPS score 2/5 or less; at 6 months follow-up, 77% of patients (N = 14) had BPS score 2/5 or less; and at 12-month follow-up, 63% of patients (N = 11) reported BPS score 2/5 or less. Patients with good outcomes had no further pain-related hospital admissions. The most sustained results were achieved amongst patients with post-herpetic neuralgia. Complications included infection in 2 patients, and refractory pain in 3 patients requiring re-intervention at 10 months post-PNFS on average. CONCLUSIONS: This case series demonstrates the utility of PNFS for CPS refractory to traditional medical and surgical management. All patients reported significant pain relief with improvement of function early in the post-operative period. Different etiologies of CPS and PNFS technology may partially explain the variability in long-term outcomes. PNFS technology is continuously optimizing pulse settings and technical characteristics and may be an adequate intervention for refractory CPS.