Percutaneous Trigeminal Nerve Stimulation for Persistent Idiopathic Facial Pain: A Case Series

Abstract

Background: Persistent idiopathic facial pain (PIFP) can be refractory to conventional management approaches. Neuromodulatory procedures such as percutaneous trigeminal nerve stimulation (TNS) have been sparsely reported as potential treatment options for amelioration of debilitating refractory pain associated with PIFP. The present study investigated the use of percutaneous TNS in a series of patients with PIFP to evaluate the potential efficacy of pain relief.

Methods: We performed a retrospective medical record review for patients with PIFP who had presented to Emory University Hospital and had undergone TNS for PIFP. The primary outcomes were postoperative pain using the visual analog scale (VAS) for pain and morphine equivalent use. Descriptive statistics, mean ± standard deviation, and the nonparametric Wilcoxon sign rank test were used, as appropriate. A P value of <0.05 was considered statistically significant.

Results: A total of 23 patients underwent percutaneous TNS for PIFP. Of the 23 patients, 20 (86.9%) reported a >50% improvement after trial stimulation. Of the patients who had received permanent TNS implants, 13 of 17 (76.4%) had VAS scores available. For these patients, the mean preoperative VAS score had decreased from 5.69 ± 2.09 to 0.15 ± 0.55 postoperatively. The VAS scores displayed a statistically significant decrease after TNS (P = 0.0014). A subset of 9 patients with available data also demonstrated a significant reduction in morphine equivalent use after TNS (before, 50.54 ± 51.30; after, 25.83 ± 33.58; P = 0.048).

Conclusion: The results from the present study have indicated that percutaneous stimulation of the trigeminal nerve is efficacious in the treatment of PIFP and can significantly decrease morphine equivalent use. Further longitudinal studies are required to validate our results.

Keywords: Atypical facial pain; Chronic pain; Neuromodulation; Percutaneous trigeminal stimulation; Persistent idiopathic facial pain; Trigeminal neuralgia.