gms | German Medical Science

Background: Peripheral nerve field stimulation (PNFS) is a promising modality for treatment of intractable facial pain. However, evidence is sparse. We are therefore presenting our experience with this technique in a small patient cohort with an update on our published data.

Materials and methods: Records of 13 patients (6 men, 7 women) with intractable facial pain who underwent implantation of one or several subcutaneous electrodes for trigeminal nerve field stimulation were analyzed. Patients’ data, including pain location, etiology, duration, previous treatments, long-term effects and complications, were evaluated.

Results: Four patients suffered from recurrent classical trigeminal neuralgia (CTN), three had CTN and were medically unfit for microvascular decompression. Three patients suffered from trigeminal neuropathy (TN) attributed to multiple sclerosis, one from post-herpetic neuropathy, one from TN following radiation therapy, and one from persistent idiopathic facial pain. Average patient age was 73.4 years (range 57-87), and average symptom duration was 11.4 years (range 2-17). Ten out of thirteen patients proceeded to implantation after successful trial. Average follow-up after implantation was 16 months (range 2-36). Eight out of ten patients showed a response to stimulation while in two, an initial response was followed by loss of effect. Using the visual analogue scale, average pain intensity was 9.3 (range 7-10) preoperatively and <1 (range 0-3) postoperatively among the responders (2.2 considering the non-responders). Complications comprised an electrode defect which entailed replacement, a wound breakdown requiring a local revision, one infection with explantation (reimplantation planned), and an IPG-dislocation without surgical consequence.

Conclusion: PNFS may be an effective treatment for refractory facial pain when established therapies have failed. Complication rates need to be reduced in the future.

Figure 1 [Fig. 1]