Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic
pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the
peripheral nervous system resulting in chronic facial pain over the distribution of the injured
nerve. First line treatment of TNP includes management with anticonvulsant medication
(carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can
be a condition difficult to adequately treat with medical management alone.
Patients with TNP can suffer from significant morbidity as a result of inadequate treatment
or the side effects of pharmacologic therapy. TNP refractory to medical management can
be considered for treatment with a growing number of invasive procedures. Peripheral
nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively
treat medically intractable TNP.
We present a case series of common causes of TNP successfully treated with PNS with
up to a 2 year follow-up. Only one patient required implantation of new electrode
leads secondary to electrode migration. The patients in this case series continue to have
significant symptomatic relief, demonstrating PNS as an effective treatment option for
intractable TNP.
Though there are no randomized trials, peripheral neuromodulation has been shown to
be an effective means of treating TNP refractory to medical management in a growing
number of case series. PNS is a safe procedure that can be performed even on patients that
are not optimal surgical candidates and should be considered for patients suffering from
TNP that have failed medical management.
Key words: Trigeminal neuropathic pain, peripheral nerve stimulation, neuromodulation,
intractable pain, facial trauma, postherpetic neuralgia
Percutaneous Peripheral Nerve Stimulation to Control Postoperative Pain, Decrease Opioid Use, and Accelerate Functional Recovery Following Orthopedic Trauma
