Trigeminal Nerve Stimulation

Trigeminal nerve stimulation is a safe and minimally invasive therapy for treating patients with severe facial pain. It is a flexible tool that can be used almost anywhere in the face and for a wide variety of conditions, including post-herpetic neuralgia (i.e. chronic facial pain after a shingles attack), anesthesia dolorosa, pain after dental or sinus procedures, and other forms of trigeminal neuropathic pain.

Trigeminal nerve situation is usually reserved for situations where patients have neuropathic pain - generally constant and sometimes burning - rather than neuralgic pain (intermittent zaps/stabs/jolts of intense pain). In some cases, it can be used as a salvage therapy for patients who have failed other interventions for trigeminal neuralgia. Nerve stimulation is a less invasive alternative to other procedures that have been used historically: nucleus caudalis DREZ and trigeminal tractotomy.

Trigeminal nerve stimulation involves inserting thin wires beneath the skin in the area of pain. The procedure is performed in two stages, both as an outpatient. The first stage is referred to as a stimulator trial. I insert temporary wires that come out through the skin and are connected to an external battery pack. The battery pack delivers targeted electrical impulses to the nerves in the face that are causing pain. The patient tries the therapy for 1 week. The wires are then pulled out in the office.

If a patient has benefit from the trial stimulator, I implant a permanent stimulator in a second procedure. The permanent system is entirely under the skin. The wires implanted into the face are tunneled to a small battery placed beneath the collarbone, similar to a heart pacemaker. The main risks are infection of the device and a wearing off of pain relief over time. I choose patients very carefully for this procedure, and part of the evaluation includes a meeting with a pain psychologist.

Trigeminal nerve stimulation often provides dramatic pain relief for patients who have exhausted other treatment options. Unfortunately, many patients (and doctors!) are not aware that it may be an option. Of note, it represents an off-label use of a spinal neurostimulator, meaning that the device is approved by the FDA for treating pain by placing it on the spinal cord; instead, I am using it to treat pain in the face by placing it on nerves in the face.