gms | German Medical Science

Objective: Trigeminal neuropathic pain (TNP) is often refractory to treatment. Peripheral nerve stimulation (PNS) has been effectively used to treat neuropathic pain of supra- and infraorbital branches of the trigeminal nerve at exiting foramens of the skull. For further improvement of the effectiveness and long-term patient satisfaction after peripheral stimulation in TNP, we used inter-lead field stimulation and analyzed the questionnaire results of the temporary trial.

Method: In three cases of refractory trigeminal pain, two octapolar electrodes were implanted, under local anaesthesia, in the region of pain distribution and connected to an external generator. Inter-Lead stimulation was applied. The electrodes were explanted after a trial phase of 10-12 days and questionnaires were completed throughout and after the trial. A patient interview was performed 10-14 days later to analyse the benefit of stimulation and quality of life (QoL).

Results: In two cases, a second surgery under general anaesthesia was performed to implant the PNS system including an infraclavicular permanent pulse generator. The indication for the implantation was not only based on pain relief or a reduction of medication, but also on improvement of activities and QoL. Patient assessment and expectations were also recorded. Both patients asked for the implantation explicitly and reported clear stable improvements at the 3 and 6 month follow-up visits. One patient did not receive a permanent implantation. She reported a 50% pain reduction after the trial without certain improvement of QoL.

Conclusions: Subcutaneous peripheral field stimulation seems to be an effective method to treat TNP. Temporary trial and evaluation of QoL and patient’s self-assessment seem to be important instruments to better select cases possibly benefiting from stimulation. The indication for permanent implantation regarding patient satisfaction by evaluation of the questionnaire should be analyzed on a larger scale.