High-Frequency Supraorbital Nerve Stimulation With a Novel Wireless Minimally Invasive Device for Post-Traumatic Neuralgia: A Case Report

Abstract

Background: Post-traumatic neuropathic pain in the head and face is a condition that is often refractory to medical management. Peripheral nerve stimulation (PNS) can be an effective treatment. Successful implantation of a novel minimally invasive wireless device is reported here.

Objective: To assess analgesic effects of a minimally invasive wireless PNS device in the treatment of post-traumatic supraorbital neuralgia (SON).

Case summary: The patient presented with SON following multiple post-traumatic cranioplasty surgeries, which were complicated by infections. Medical and interventional management failed, and the patient reported a numeric rating scale (NRS) pain score of 8 out of 10. Two octopolar implantable neural stimulators (INSs) (StimRelieve LLC, Pompano Beach, FL, U.S.A.) were implanted with a minimally invasive, percutaneous technique to stimulate the supraorbital nerves. Stimulation parameters were set at a frequency of 10 kHz and a pulse width of 30 microseconds.

Results: At 12- and 24-month follow-up evaluations, the patient’s NRS score was only 2 out of 10, and the patient occasionally required 1 g of paracetamol to control the pain. Stimulation was reported to be paresthesia free. There were no adverse events related to the procedure or the treatment until today.

Conclusions: High-frequency stimulation with an external pulse generator and minimally invasive, percutaneous, and bilateral placement of 2 passive INSs on the supraorbital nerves resulted in a significant pain relief in this patient with post-traumatic SON. The device was safe and effective, and the cosmesis was satisfactory.

Keywords: neuromodulation; peripheral nerve stimulation; post-traumatic headache; supraorbital neuralgia; wireless.

© 2018 World Institute of Pain.