Background: High frequency wireless Spinal
Cord Stimulation (SCS) at the C1-C2 vertebral
levels provides analgesia for the treatment of
refractory ocular pain on the left side secondary
to post-herpetic neuralgia.
Objective: To assess analgesic effects of minimally
invasive wireless neuromodulation in the
treatment of chronic pain due to post-herpetic
neuralgia.
Study Design: This observational, prospective
case report was designed to illustrate the effectiveness
of relieving chronic, intractable pain
utilizing wireless spinal cord stimulation at multiple
frequencies for the treatment of post-herpetic
neuralgia.
Setting: Private Practice Interventional Pain
Clinic.
Methods: This is a single case study of a 62-yearold
patient who experienced an episode of
shingles with rash over the left frontal and lateral
ocular margin. After the rash subsided, the patient
began suffering from severe pain in the left eye.
The patient was placed on a 10-day course of
valacyclovir, gabapentin, which was discontinued
secondary to sedation intolerance, pregabalin
titrated to 300 mg/day and oxycodone, all of which
were ineffective in relieving the pain. The patient
received a stellate ganglion block injection on 6
occasions, experiencing pain relief of only up to
one-day after each injection. Stellate ganglion
radiofrequency ablation was also unsuccessful.
With original Visual Analog Scale (VAS) score of
9/10, inability to sleep and incapacity to perform
activities of daily living (ADLs), the patient had
Stimwave Freedom wireless stimulators placed
sequentially at the C1-C2 vertebral levels.
Results: Programming at low frequencies from
40-120 Hz was unsuccessful in reducing left eye
pain. Stimulation was increased to high frequency
on the Stimwave SurgeTM adjustable waveform,
and within 12 hours, the patient noted significant
decrease in pain. At 3 days post-procedure, the
patient’s VAS score was 1/10. The patient had
permanent placement of the devices, and at
8-month follow-up, VAS scores were 0-2/10, and
the patient’s mood, sleep and ability to perform
ADLs all improved substantially.
Limitations: The study was limited by the novelty
of the device. Although the doctor who implanted
the device is very experienced, more cases of the
use of the wireless Stimwave Freedom apparatus
are necessary to establish its long-term effectiveness
and safety. More clinical trials investigating
the utilization of multiple frequencies are also
required.
Conclusions: Epidural placement of 2, wireless
sequentially placed octopolar stimulators with a
minimally invasive technique at high frequency
stimulation was safe and effective.
Key words: post-herpetic neuralgia, ocular, spinal
cord stimulation, wireless, shingles, trigeminal
nerve, high frequency
High Frequency Spinal Cord Stimulation for
Complex Regional Pain Syndrome: A Case
Report