Peripheral nerve stimulation as a potentially viable treatment option for neuropathic facial trigeminal pain

Peripheral nerve stimulation (PNS) could be a viable treatment option for patients with trigeminal neuropathic facial pain (TNP), according to the results of a systematic review and meta-analysis published in Neuromodulation.

Researchers at Central South University in China searched publication databases for studies on neuropathic pain and implantable neurostimulators through October 2020. A total of 13 studies with 221 patients were included in the final analysis.

Most of the patients were women (59.7%) with TNP (85%). Other diagnoses included atypical trigeminal neuralgia, ophthalmic herpes zoster, post-herpes zoster neuralgia, persistent idiopathic facial pain, supraorbital neuralgia, symptomatic trigeminal neuralgia, trigeminal defermentation pain, temporomandibular joint disease, trigeminal neuralgia, and headache.

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The response rate to PNS (pain relief> 50%) was 60.2% (95% CI, 41.9% to 76.1%; I2, 70.733%; P <0.0001). Compared to baseline, PNS was associated with an improvement in pain scores of 2.363 (95% CI, 1.408–3.319; I2, 85.723%; P <0.0001).

Stratified by subgroup, the response rate of the combined etiologies was 69.1% (95% CI, 42.8% to 87.0%; I2, 76.315%; P = 0.001) and in the ABP subgroup the response rate was 47.0% (95%). CI 23.5% to 71.9%, I2 62.160%, P = 0.048).

Stratified according to the PNS target, the response rate for stimulation of the gas ganglion was 29.3% (95% CI 19.2% to 41.8%; I2.0%; P = 0.635) and 77.6% for stimulation of the peripheral Zweig (P <0.0001), and 52.2% (95% CI, 32.5% to 71.2%; I2, 0%; P = 1) for stimulation of the trigeminal nerve root.

Commonly reported adverse events included electrode displacement, infection, physical discomfort, surgical revision, and loss of effectiveness.

This analysis was limited by the fact that no studies had randomized designs, significant heterogeneity was observed, and the combined etiology group had few patients with multiple diagnoses.

The study’s authors concluded that PNS could be a viable treatment option for patients with TNP, especially those who are not candidates for conventional therapies. Stimulating the peripheral trigeminal branches may be more effective than stimulating the gasserian ganglion. Additional randomized trials are required.

reference

Y. Ni, L. Yang, R. Han et al. Implantable peripheral nerve stimulation for trigeminal neuropathic pain: a systematic review and meta-analysis. Neuromodulation. Published online May 18, 2021. doi: 10.1111 / ner.13421

This article originally appeared on Clinical Pain Advisor