Salmasi Vafi, Olatoye Oludare O, Terkawi Abdullah Sulieman, Hah Jennifer M, Ottestad Einar, Pingree Matthew
Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Pain Med. 2020 Aug 1;21(Suppl 1):S13-S17. doi: 10.1093/pm/pnaa083.
Chronic headaches are the second most prevalent disease and second most common cause for years lived with disability worldwide. Occipital neuralgia can cause headaches or be present in addition to other more prevalent causes of headache. If these headaches fail to respond to conservative and pharmacological therapy, physicians proceed to more invasive treatments, starting with infiltration of the greater occipital nerve with local anesthetic with or without corticosteroids, followed by nerve ablation or stimulation. Occipital nerve stimulation gained more popularity as the technology improved and more pain physicians received training on interventional procedures.
In this manuscript, we are presenting our experience with ultrasound-guided implant of occipital nerve stimulators using peripheral nerve stimulator systems. After confirming appropriateness of treatment by a successful occipital nerve block (i.e., resulting in >50% relief in patients' pain intensity), we implanted five stimulator systems in three patients (two bilateral).
We followed these patients for an average of eight months, and the average pain reduction was ∼50%. We did not observe any adverse events during or immediately after surgery. One patient developed an adverse reaction to the adhesive of the battery transmitter, but it was not severe enough to stop her from using the stimulator.
Considering the ease of implant and minimal side effects, implant of peripheral nerve stimulators to stimulate the occipital nerve is a promising treatment modality for patients with chronic headache who present with features of occipital neuralgia. However, wider use of this treatment modality is subject to further studies.
慢性头痛是全球第二大常见疾病，也是导致残疾生存年限的第二大常见原因。枕神经痛可引发头痛，或与其他更常见的头痛病因并存。若这些头痛对保守治疗和药物治疗无效，医生会采取更具侵入性的治疗方法，首先是用局部麻醉剂（加或不加皮质类固醇）浸润枕大神经，随后进行神经消融或刺激。随着技术的改进以及越来越多的疼痛科医生接受介入手术培训，枕神经刺激术越来越受欢迎。
在本论文中，我们介绍了使用外周神经刺激器系统进行超声引导下枕神经刺激器植入的经验。在通过成功的枕神经阻滞确认治疗的适宜性（即患者疼痛强度减轻>50%）后，我们为三名患者（两名双侧植入）植入了五个刺激器系统。
我们对这些患者平均随访了八个月，平均疼痛减轻约50%。在手术期间或术后即刻，我们未观察到任何不良事件。一名患者对电池发射器的粘合剂出现不良反应，但严重程度不足以使其停止使用刺激器。
考虑到植入操作简便且副作用极小，对于具有枕神经痛特征的慢性头痛患者，植入外周神经刺激器以刺激枕神经是一种有前景的治疗方式。然而，这种治疗方式的更广泛应用有待进一步研究。
