04 Paul Verrills NANS 2010 ONL by HC12083023379

VIEWS: 4 PAGES: 18

									     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
Disclosure Statement
No 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)




                                   Degree of disability following
                                           Implantation                80% of patients reported reductions
                             100                                       in their disability following
                                                                       implantation (p ≤ 0.05)
 Neck Disability Index (%)




                              80
                                                                       Median NDI reduced by 8.2 ± 8.6%
                              60                 62.1
                                                              56.7


                              40


                              20


                               0
                                       Pre Implant      Post Implant
PNFS for occipital/craniofacial pain: Reduced Depression


                                       Depression following Implantation
  Zung Depression SDS Index (%)




                                  80
                                                                               70% of patients reported
                                                                            reductions in their depression
                                  60                                         index following implantation
                                                      55.1
                                                                                       (p ≤ 0.05)
                                                                   47.0

                                  40
                                                                            Median Zung reduced by 9.2 ±
                                                                                       9.9%
                                  20


                                   0
                                          Pre Implant        Post Implant
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


     Complication         No. of                        Outcome
                         Patients
                                     Reposition / Re-implant /    Explanted
                                             Replace


 Hardware Erosion            9                  6                    3



 Lead Infection              2                  1                    1



 Hardware Migration          1                  1                     -



  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.




                                            pverrills@metrospinal.com.au
                                                  www.metrospinal.com.au

								
To top