Treatment of Persistent Idiopathic Facial Pain with High Cervical Spinal Cord Stimulation: Case Report

Abstract

Abstract Introduction: Facial pain presents complex clinical challenges for the treating clinician, whether those arise from 1) a diagnostic standpoint with identifying the source of pain; 2) dealing with medication side effects at higher doses; or 3) issues with identifying small anatomical structures for interventional or surgical treatment. Atypical facial pain, now known as persistent idiopathic facial pain (PIFP), is no exception to these rules, and is often more refractory than other types of facial pain to conventional treatment options. Neuromodulation (including both spinal cord and peripheral nerve stimulation) has been described to treat some types of facial pain, with the best evidence available thus far for trigeminal neuralgia, but there is limited evidence thus far for PIFP. Case Presentation: We review here the case of a 70-year-old man with significant PIFP versus trigeminal neuralgia, refractory to medications and other interventions. He had excellent relief of his pain with high cervical spinal cord stimulation, and we address the diagnostic challenges related to the true source of pain (equivocal results from interventional procedures) as well as the numerous failed treatment modalities in his care. Conclusions: High cervical and cervicomedullary spinal cord stimulation has potential to treat persistent facial pain other than that related to trigeminal neuralgia, and we hope to see more literature for these challenging facial pain states moving forward.