Peripheral Nerve Stimulation (PNS) for Treatment of Intractable Headaches Associated with Lyme Disease

Peripheral Nerve Stimulation (PNS) for Treatment of Intractable Headaches Associated with Lyme Disease

Alexander E. Yakovlev, M.D. and Beth E. Resch, Comprehensive Pain Management of the Fox Valley, SC, Appleton, Wisconsin, Appleton, WI

Introduction: Lyme disease is a bacterial infection caused by Borrelia burgdoferi. It affects various body systems including the nervous system. The patients may multiple pain areas and intractable neuropathic pain despite conventional treatments. Control of headaches associated with Lyme disease is challenging despite numerous treatment modalities available in the field of pain management. Peripheral nerve stimulation (PNS) has been used to treat patients with injuries to a specific nerve,1 including application to occipital,2 ilioinguinal,3 supraorbital, and trigeminal neuralgia. Recently this type of treatment is utilized to control headaches.

Materials and Methods: A 29 year-old male with Lyme disease and 8 year history of chronic joint pain and intractable diffuse hedaches had previously failed conservative therapy and had minimal pain relief after multiple nerve blocks. Seven years earlier he underwent surgery for incidentally found Chiari malformation which made his headaches even worse. The patient had successful PNS trial with percutaneous placement of two 8-electrode leads positioned in left and right occipital region. During the 2 day PNS trial the patients reported greater than 90% improvement in pain. Two weeks later he underwent implantation with permanent leads and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator. Stimulator parameters programmed with amplitude 1.5 volts, pulse width 450 microseconds, and frequency 30 Hz.

Results: After final implantation the patient reported complete elimination of headaches with permanent stimulator. The patient was able to decrease and discontinue use of pain medications. He also reported other positive outcomes including the ability to return occupational activities and improved family relationships.

Conclusion: Peripheral nerve stimulation appears to be a therapeutic alternative for patients with chronic intractable headaches who in the past exhausted all available treatments. This technique is a relatively easy to perform, effective, and safe procedure. The therapy is reversible should patients lose its pain-alleviating effect or headaches resolve.

References

1. Novak CB, Mackinnon SE. Outcome following implantation of a peripheral nerve stimulator in patients with chronic nerve pain. Plast Reconstr Surg 2000;105:1967-1972.

2. Slavin KV, Nersesyan H, Wess C. Peripheral neurostimulation for treatment of intractable occipital neuralgia. Neurosurgery 2006;58:112-119.

3. Stinson LW Jr, Roderer GT, Cross NE, Davis BE. Peripheral subcutaneous electrostimulation for control of intractable post-operative inguinal pain: a case report series. Neuromodulation 2001;4:99-104.