• André Marques Mansano, Nouer FredericoThiagoTInterventional Pain Management, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil., Sergio Luiz de Mirando, and Adonai Peixoto Cheim Junior.
• Interventional Pain Management, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
• Pain Med. 2023 Mar 1; 24 (3): 300305300-305.

BackgroundTrigeminal neuralgia is considered the worst pain a human being can experience. Initial treatment uses anticonvulsant sodium channel blockers, which relieve pain in approximately 70% of patients. In refractory cases, it is possible to perform ablative treatments, decompressive surgeries, and neuromodulatory techniques.MethodsThis report describes the treatment of a patient with refractory trigeminal neuralgia who continued to have a painful clinical presentation after four surgical procedures and three ablative procedures. The patient presented with severe pain (verbal numerical scale between 9 and 10), manifesting an evident suicidal ideation. A dorsal root ganglion (DRG) stimulation electrode was implanted in the trigeminal ganglion through intraoral puncture with maxillary fixation of the electrode, in order to minimize the chances of displacement. The test phase consisted of implanting a quadripolar electrode for DRG stimulation through puncture lateral to the buccal rim in a fluoroscopic coaxial view. The electrode was fixed to the skin and maintained for 5 days, during which the patient remained completely pain free. After the 5-day test period, the definitive stimulation electrode was implanted, this time with intraoral puncture and maxillary electrode fixation.ResultsThe patient remains pain free in the 3-month follow-up, with no displacement of the electrode.ConclusionsThe DRG electrode may be considered a therapeutic option in patients with severe trigeminal neuralgia. Controlled studies must be performed to determine the efficacy and safety of the method.© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

14 keywords...

hide…