Poor Effectiveness of Occipital Nerve Stimulation in Treating Refractory Neuropathic Facial Pain: A Case Series.

Context: Neuropathic facial pain (NFP) that remains refractory to optimal pharmacologic management imposes a significant burden on patients and a challenge to pain specialists. Recent clinical evidence indicates that peripheral nerve stimulation (PNS) exhibits therapeutic potential in managing occipital and facial neuropathic pain. This study aims to evaluate the effectiveness of occipital nerve stimulation (ONS) specifically in the treatment of NFP.

Materials and methods: We conducted a retrospective case series involving prospectively enrolled patients with refractory NFP unresponsive to optimal specific medical therapy and in some instances motor cortex stimulation. These patients were treated under a compassionate use framework for unilateral NFP using ONS. Each patient underwent an initial ONS trial lasting a minimum of two weeks. If they experienced an alleviation of their NFP >40%, they proceeded to definitive implantation one month later.

Results: Overall, 13 patients were included in the study, with a mean age of 66 years and a male-to-female ratio of 1.2:1. The average duration from NFP onset to ONS surgery was 9.6 years. During the trial period, only six patients (46%) experienced significant improvement and proceeded to implantation. However, three of these patients (23%) did not report any benefit one month after implantation, motivating hardware removal. In addition, in two patients (15%), the initial improvement did not translate to long-term relief. Ultimately, only one patient (8%) reported sustained long-term improvement in NFP. Notably, this patient had experienced a ten-year benefit from motor cortex stimulation before they underwent ONS.

Conclusion: In light of our results, the limited and inconsistent improvements observed in a minority of patients suggest that ONS may not be a reliable surgical treatment option for NFP.