Neuromodulation for Headache & Craniofacial Pain: 50 Consecutive Cases Paul Verrills MD, David...
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Transcript of Neuromodulation for Headache & Craniofacial Pain: 50 Consecutive Cases Paul Verrills MD, David...
Neuromodulation for Headache & Craniofacial Pain:
50 Consecutive Cases
Paul Verrills MD, David Vivian MD, Bruce Mitchell MD and Adele Barnard PhD
Metro Spinal Clinic, Melbourne
Dr Paul Verrills Musculoskeletal PhysicianMBBS FAFMM GDMM(Hons) MPainMed FIPP
Disclosure StatementNo funds have been received in support of this study
Royalties: NIL
Stock Options: NIL
Teaching – Consultant (adhoc peer-peer)
- St. Jude Medical
- Arthrocare
- Mundipharma
- Medtronic
- Boston Scientific
Research Grant: NIL
Travel Support: NIL
Chronic Craniofacial Pain
Treatment of chronic neuropathic pain in the region of the head, neck and face presents a challenge for pain specialists.
Peripheral nerve field stimulation (PNFS) is evolving as a treatment for neuropathic pain
Increase in the number of cases of PNFS for the craniofacial region since the publication of Richard Weiner’s study in 1999.
Supraorbital Trial
Supraorbital Leads
Right Supraorbital and right vertical occipital leads
Occipital and Supraorbital Leads – Unilateral Chronic Daily headache
Supraorbital
Occipital
Occipital Stimulation - Migraines
PNFS for headache and craniofacial pain: Patient Selection
Chronic Daily Headache / Occipital Neuralgia / ‘Migraine’
Neuropathic or combined somatic (nociceptive) & neuropathic pain component.
Failure to respond to other conservative treatments
Red flags excluded
Psychological clearance
Successful trial phase (eg. >50% pain relief)
Informed consent
PNFS for headache and craniofacial pain: Study Design
Data collected over 4 years
50 consecutive implant patients
Follow up rate of 100%
Assessments
Questionnaires, along with patients’ histories were used to assess
Pain (11-point numerical rating scale)
Analgesic use
Depression (Zung Depression Index)
Disability (Neck Disability Index)
Follow up of mean 10.8 ± 6.5 months (range 1-36 months)
PNFS for headache and craniofacial pain: Decrease in Pain
Average pain reduction of 4.8± 2.4 NRS (p ≤ 0.05)
Average pain relief of 62.6 ± 26.4%
Pain Relief
88% of patients achieved ≥ 25%
76% of patients achieved ≥ 50%
43% of patients achieved ≥ 75%
PNFS for headache and craniofacial pain: High patient satisfaction rate
82% of patients were satisfied with their treatment outcome
61% of patients were either very or completely satisfied
PNFS for headache and craniofacial pain: Reduced Analgesic use
77% of patients reported a reduction in analgesic use
66% of patients reported a moderate to extreme decrease
Reduction in analgesic use inversely correlated with pain relief (r = 0.75, p ≤0.05)
patient satisfaction (r = 0.69, p ≤0.05)
PNFS for headache and craniofacial pain: Reduced Disability (NDI)
80% of patients reported reductions in their disability following implantation (p ≤ 0.05)
Median NDI reduced by 8.2 ± 8.6%
Degree of disability following Implantation
0
20
40
60
80
100
Pre Implant Post Implant
Nec
k D
isab
ilit
y In
dex
(%
)
62.156.7
PNFS for occipital/craniofacial pain: Reduced Depression
70% of patients reported reductions in their depression index following implantation
(p ≤ 0.05)
Median Zung reduced by 9.2 ± 9.9%
Depression following Implantation
0
20
40
60
80
Pre Implant Post Implant
Zu
ng
De
pre
ss
ion
SD
S I
nd
ex
(%
)
55.1
47.0
PNFS for occipital/craniofacial pain: Sustained Pain Relief
Pain relief achieved initially following implantation was
sustained at follow up intervals of ≥12 months.
PNFS for occipital/craniofacial pain: Complications
Two thirds of patients achieved favorable outcomes following reposition and/or re-implantation
Complication No. of Patients
Outcome
Reposition / Re-implant / Replace
Explanted
Hardware Erosion 9 6 3
Lead Infection 2 1 1
Hardware Migration 1 1 -
PNFS for occipital/craniofacial pain: Summary
Average pain reduction of 4.9± 2.5 VAS (p ≤ 0.05)
Average pain relief of 63.1 ± 27.0%.
Reduced disability, analgesic use and depression was observed following PNFS
Reduction in analgesic use inversely correlated with pain relief and patient
satisfaction
This study demonstrates that this reversible, safe and effective treatment is a
promising pain relief strategy for an otherwise intractable condition.
www.metrospinal.com.au