Non-invasive trial testing for trigeminal branch stimulation to treat refractory trigeminal neuropathic pain: A technical note

Maragkos, Georgios A; Gomez-Paz, Santiago; Salem, Mohamed M.; Baum, Patricia; Arle, Jeffrey E.

doi:10.1016/j.inat.2020.100767

Cited by 2 publications

(8 citation statements)

References 7 publications

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“…Individual patient data were available for 62 patients from 8 studies. [1][2][3][5][6][7][8]11 The mean improvement in VAS pain score at last follow-up for this cohort was 6.3 (95% CI 5.5-7.1, paired t-test, p < 0.001), with 79% (49/62) having a postoperative pain score < 5 (Fig. 3).…”

Section: Last Follow-upmentioning

confidence: 84%

“…The duration of trials performed in the study using superficial adhesive electrodes was reported as 2 hours. 8 The range of medians for pain reduction during trial stimulation was 60%-87.5%, reported in 3 studies. 1,3,8 Permanent Implantation Phase A total of 94 patients (86% of the total trialed patients) underwent permanent system implantation.…”

Section: Trial Phasementioning

confidence: 96%

“…8 The range of medians for pain reduction during trial stimulation was 60%-87.5%, reported in 3 studies. 1,3,8 Permanent Implantation Phase A total of 94 patients (86% of the total trialed patients) underwent permanent system implantation. In 73% of the studies, the system manufacturer was Medtronic (Table 2).…”

Section: Trial Phasementioning

confidence: 96%

“…Evidence supporting the utility of PNFS for treating trigeminal pain is based solely on uncontrolled retrospective and prospective observational studies. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Until the results of high-quality RCTs become available, we argue that a meta-analysis of reported outcomes provides the strongest support for the use of PNFS for trigeminal pain. In this paper, we identify studies that report on outcomes of PNFS for trigeminal pain and perform a meta-analysis of the outcomes to estimate efficacy.…”

mentioning

confidence: 97%

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PeriPheral nerve field stimulation (PNFS) has been used for the treatment of trigeminal pain, but its efficacy has yet to be established. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] This therapeutic modality involves subcutaneous electrode implantation in the vicinity of trigeminal nerve branches and application of electrical current using a permanently implanted pulse generator. 9 Similar to other forms of neuromodulation, PNFS is nonablative, reversible, adjustable, and ABBREVIATIONS BNI = Barrow Neurological Institute; IPG = implantable pulse generator; MVD = microvascular decompression; NRS = numeric rating scale; PGP = percutaneous gasserian ganglion procedure; PHN = postherpetic neuralgia; PIFP = persistent idiopathic facial pain; PNFS = peripheral nerve field stimulation; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RCT = randomized controlled trial; SRS = stereotactic radiosurgery; STN = symptomatic trigeminal neuralgia; TDP = trigeminal deafferentation pain;

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mentioning

confidence: 99%

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Clinical outcomes and complications of peripheral nerve field stimulation in the management of refractory trigeminal pain: a systematic review and meta-analysis

Sarica

Iorio-Morin

Aguirre-Padilla

et al. 2022

Journal of Neurosurgery

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OBJECTIVE Peripheral nerve field stimulation (PNFS) is a tool in the armamentarium of treatment options for trigeminal pain. The efficacy of this modality in mitigating trigeminal pain remains unclear. The aim of this study was to examine the existing literature on PNFS and elucidate pain score outcomes associated with its use in patients with trigeminal pain. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA framework. The PubMed, Web of Science, and Scopus databases were queried on June 10, 2020. Studies reporting pain outcomes in more than 5 adult patients treated with PNFS for facial pain were included. The primary outcome of the study was the mean difference in the visual analog scale (VAS) score from the last follow-up to baseline, and it was analyzed by an inverse-variance, random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale and a funnel plot. RESULTS Of the 4597 studies screened for inclusion, 46 relevant full-text articles were assessed for eligibility. Eleven observational cohort studies from the 46 articles were found to be eligible, and reported on a total of 109 patients. In 86% (94/109) of cases, trial stimulation was successful and followed by a permanent system implantation. VAS scores improved by 75% (mean difference 6.32/10 points, 95% CI 5.38–7.27 points) compared to baseline. Seventy-six percent (42/55) of patients became medication free or required lower doses of medications. The complication rate necessitating surgical revision was estimated at 32% per procedure. CONCLUSIONS These findings support the belief that PNFS provides effective, long-term pain control for trigeminal pain. Statistical heterogeneity was considerable across all studies. Future work should be aimed at conducting double-blind randomized controlled trials to determine the utility of PNFS for treating various forms of trigeminal pain for which limited therapeutic options exist.

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Section: Last Follow-upmentioning

confidence: 84%

Section: Trial Phasementioning

confidence: 96%

Section: Trial Phasementioning

confidence: 96%

mentioning

confidence: 97%

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mentioning

confidence: 99%

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Clinical outcomes and complications of peripheral nerve field stimulation in the management of refractory trigeminal pain: a systematic review and meta-analysis

Sarica

Iorio-Morin

Aguirre-Padilla

et al. 2022

Journal of Neurosurgery

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Estimulación eléctrica continua para el tratamiento de la neuralgia del trigémino

Acevedo Gonzalez,

Bello Romero

2023

Rev. Soc. Esp. Dolor.

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Introducción: El dolor facial incluye un grupo de patologías de muy difícil diagnóstico y tratamiento. Su respuesta al manejo médico puede ser limitada y se convierte en un dolor crónico de difícil tratamiento. Nuevas técnicas de tratamiento invasivo con estimulación eléctrica continua (EEC) se están evaluando para su utilización.Objetivos: Revisar la evidencia actual relacionada con el uso de la estimulación eléctrica continua del nervio trigémino para el tratamiento del dolor facial crónico. Materiales y métodos:Esta revisión se realizó de acuerdo con las recomendaciones del Preferred Reporting ítems for systematic reviews and Meta-analyses (PRISMA). Se realizó una búsqueda sistemática de la literatura en los últimos 5 años utilizando 4 bases de datos. Se incluyeron para una primera revisión por parte de los autores todos los artículos en inglés y en español que tuvieran análisis poblacional. Los datos obtenidos fueron exportados a la plataforma Rayyan, en donde cada investigador realizó un análisis independiente de los resúmenes y seleccionó los artículos que cumplían con los requisitos de búsqueda.Resultados: 162 artículos fueron revisados para inclusión, de los cuales 31 fueron analizados a profundidad para determinar su elegibilidad y 131 fueron excluidos. Se incluyeron 27 artículos de texto completo incluyendo revisiones sistemáticas, revisiones narrativas, series de casos retrospectivas, cohortes de casos, metanálisis, protocolos institucionales y guías de práctica clínica. De los 27 artículos incluidos, 16 establecieron su diagnóstico de base como neuralgia trigeminal o dolor neuropático del nervio trigémino, 8 lo hicieron con dolor facial refractario, 1 con neuralgia facial postherpética, 1 con neuralgia facial secundaria a esclerosis múltiple y 1 con dolor del nervio mentoniano. Las publicaciones consultadas ofrecen tamaños de muestra pequeños, parámetros de manejo, tasas de complicaciones y esquemas de seguimiento heterogéneos que permiten hacer un análisis individual y establecer recomendaciones generales.Conclusiones: La estimulación eléctrica continua no ha demostrado aún su utilidad en el tratamiento de la neuralgia idiopática del trigémino. Puede utilizarse en algunas formas de dolor neuropático trigeminal crónico que no responda a otros tratamientos. La aplicación de EEC sobre ramas periféricas del nervio trigémino tiene un uso muy limitado y solo la estimulación continua del ganglio de Gasser podría tener un mejor futuro en el tratamiento de pacientes seleccionados.

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Non-invasive trial testing for trigeminal branch stimulation to treat refractory trigeminal neuropathic pain: A technical note

Cited by 2 publications

References 7 publications

Clinical outcomes and complications of peripheral nerve field stimulation in the management of refractory trigeminal pain: a systematic review and meta-analysis

Clinical outcomes and complications of peripheral nerve field stimulation in the management of refractory trigeminal pain: a systematic review and meta-analysis

Estimulación eléctrica continua para el tratamiento de la neuralgia del trigémino

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