University of Arizona, Tucson, AZ 85724, USA.
Pain Physician. 2012 Jan-Feb;15(1):27-33.
Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can be a condition difficult to adequately treat with medical management alone. Patients with TNP can suffer from significant morbidity as a result of inadequate treatment or the side effects of pharmacologic therapy. TNP refractory to medical management can be considered for treatment with a growing number of invasive procedures. Peripheral nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively treat medically intractable TNP. We present a case series of common causes of TNP successfully treated with PNS with up to a 2 year follow-up. Only one patient required implantation of new electrode leads secondary to electrode migration. The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management.
面部疼痛是一种复杂的疾病，可能有多种病因。三叉神经病理性疼痛（TNP）定义为由于三叉神经周围神经系统分支的损伤或疾病引起的疼痛，导致损伤神经分布区域的慢性面部疼痛。TNP 的一线治疗包括使用抗惊厥药物（卡马西平、苯妥英钠、加巴喷丁等）、巴氯芬和镇痛药进行管理。然而，TNP 仅凭药物治疗可能难以充分治疗。由于治疗不足或药物治疗的副作用，TNP 患者可能会遭受严重的发病率。对于药物治疗无效的 TNP，可以考虑采用越来越多的侵入性治疗方法。周围神经刺激（PNS）是一种微创选择，已被证明可有效治疗药物难治性 TNP。我们报告了一系列 TNP 的常见病因病例系列，这些病因通过 PNS 治疗成功，随访时间长达 2 年。只有一名患者因电极迁移而需要植入新的电极导线。该病例系列中的患者继续有明显的症状缓解，表明 PNS 是治疗药物难治性 TNP 的有效治疗选择。虽然没有随机试验，但越来越多的病例系列研究表明，外周神经调节是治疗药物难治性 TNP 的有效方法。PNS 是一种安全的手术，即使对于不太适合手术的患者也可以进行，对于药物治疗失败的 TNP 患者，应考虑使用 PNS。
