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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 Physician MBBS FAFMM GDMM(Hons) MPainMed FIPP.
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 studyRoyalties: NILStock Options: NILTeaching – Consultant (adhoc peer-peer) - St. Jude Medical - Arthrocare - Mundipharma - Medtronic - Boston ScientificResearch Grant: NILTravel Support: NIL
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.
Occipital and Supraorbital Leads – Unilateral Chronic Daily headache
Chronic Daily Headache / Occipital Neuralgia / ‘Migraine’
Neuropathic or combined somatic (nociceptive) & neuropathic pain component.
Failure to respond to other conservative treatments
Red flags excluded
Successful trial phase (eg. >50% pain relief)
Average pain reduction of 4.8± 2.4 NRS (p ≤ 0.05)
Average pain relief of 62.6 ± 26.4%
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
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)
Degree of disability following
80% of patients reported reductions in their disability following implantation (p ≤ 0.05)
Median NDI reduced by 8.2 ± 8.6%
Neck Disability Index (%)
Zung Depression SDS Index (%)
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%
Pain relief achieved initially following implantation was sustained at follow up intervals of ≥12 months.
Two thirds of patients achieved favorable outcomes following reposition and/or re-implantation
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.