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      A Review of the Recent Findings in Minimally Invasive Treatment Options for the Management of Occipital Neuralgia

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          Abstract

          Occipital neuralgia (ON) is unilateral or bilateral neuralgia in the dermatomal nerve distribution of the greater, lesser or third occipital nerves and is a very common presentation of neuropathic pain. ON, although common and well defined, is still a poorly understood pain syndrome. It often requires invasive treatment for long term and significant pain alleviation; however, the evidence supporting different options is still limited. Several minimally invasive techniques have proven to be efficacious and safe, and the selection depends mostly on response to nerve blocks, patient choice and provider preference. This is a comprehensive review of the latest and seminal literature available about occipital neuralgia and currently available minimally invasive treatment options. It covers the anatomical and physiologic biology at the base of neuralgia, the presentation and diagnostic process. It then reviews the available literature to provide description and comparison of the available methods for alleviation.

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          Incidence of facial pain in the general population.

          Frank Huygen, Miriam C. J. M. Sturkenboom, Werner Koopman … (2009)
          Facial pain has a considerable impact on quality of life. Accurate incidence estimates in the general population are scant. The aim was therefore to estimate the incidence rate (IR) of trigeminal neuralgia (TGN), postherpetic neuralgia (PHN), cluster headache (CH), occipital neuralgia (ON), local neuralgia (LoN), atypical facial pain (AFP), glossopharyngeal neuralgia (GPN) and paroxysmal hemicrania (PH) in the Netherlands. In the population-based Integrated Primary Care Information (IPCI) medical record database potential facial pain cases were identified from codes and narratives. Two medical doctors reviewed medical records, questionnaires from general practitioners and specialist letters using criteria of the International Association for the Study of Pain. A pain specialist arbitrated if necessary and a random sample of all cases was evaluated by a neurologist. The date of onset was defined as date of first specific symptoms. The IR was calculated per 100,000PY. Three hundred and sixty-two incident cases were ascertained. The overall IR [95% confidence interval] was 38.7 [34.9-42.9]. It was more common among women compared to men. Trigeminal neuralgia and cluster headache were the most common forms among the studied diseases. Paroxysmal hemicrania and glossopharyngeal neuralgia were among the rarer syndromes. The IR increased with age for all diseases except CH and ON, peaking in the 4th and 7th decade, respectively. Postherpetic neuralgia, CH and LoN were more common in men than women. From this we can conclude that facial pain is relatively rare, although more common than estimated previously based on hospital data.
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            Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: long-term results from a randomized, multicenter, double-blinded, controlled study.

            David W Dodick, Stephen D. Silberstein, Kenneth Reed … (2015)
            Recent studies evaluated short-term efficacy and safety of peripheral nerve stimulation (PNS) of the occipital nerves for managing chronic migraine. We present 52-week safety and efficacy results from an open-label extension of a randomized, sham-controlled trial. In this institutional review board-approved, randomized, multicenter, double-blinded study, patients were implanted with a neurostimulation system, randomized to an active or control group for 12 weeks, and received open-label treatment for an additional 40 weeks. Outcomes collected included number of headache days, pain intensity, migraine disability assessment (MIDAS), Zung Pain and Distress (PAD), direct patient reports of headache pain relief, quality of life, satisfaction and adverse events. Statistical tests assessed change from baseline to 52 weeks using paired t-tests. Intent-to-treat (ITT) analyses of all patients (N = 157) and analyses of only patients who met criteria for intractable chronic migraine (ICM; N = 125) were performed. Headache days were significantly reduced by 6.7 (±8.4) days in the ITT population (p < 0.001) and by 7.7 (±8.7) days in the ICM population (p < 0.001). The percentages of patients who achieved a 30% and 50% reduction in headache days and/or pain intensity were 59.5% and 47.8%, respectively. MIDAS and Zung PAD scores were significantly reduced for both populations. Excellent or good headache relief was reported by 65.4% of the ITT population and 67.9% of the ICM population. More than half the patients in both cohorts were satisfied with the headache relief provided by the device. A total of 183 device/procedure-related adverse events occurred during the study, of which 18 (8.6%) required hospitalization and 85 (40.7%) required surgical intervention; 70% of patients experienced an adverse event. Our results support the 12-month efficacy of PNS of the occipital nerves for headache pain and disability associated with chronic migraine. More emphasis on adverse event mitigation is needed in future research. Clinical trials.gov (NCT00615342). © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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              Botulinum Toxin for Neuropathic Pain: A Review of the Literature

              Hyun-Mi Oh, Myung Chung (2015)
              Botulinum neurotoxin (BoNT), derived from Clostridium botulinum, has been used therapeutically for focal dystonia, spasticity, and chronic migraine. Its spectrum as a potential treatment for neuropathic pain has grown. Recent opinions on the mechanism behind the antinociceptive effects of BoNT suggest that it inhibits the release of peripheral neurotransmitters and inflammatory mediators from sensory nerves. There is some evidence showing the axonal transport of BoNT, but it remains controversial. The aim of this review is to summarize the experimental and clinical evidence of the antinociceptive effects, mechanisms, and therapeutic applications of BoNT for neuropathic pain conditions, including postherpetic neuralgia, complex regional pain syndrome, and trigeminal neuralgia. The PubMed and OvidSP databases were searched from 1966 to May 2015. We assessed levels of evidence according to the American Academy of Neurology guidelines. Recent studies have suggested that BoNT injection is an effective treatment for postherpetic neuralgia and is likely efficient for trigeminal neuralgia and post-traumatic neuralgia. BoNT could also be effective as a treatment for diabetic neuropathy. It has not been proven to be an effective treatment for occipital neuralgia or complex regional pain syndrome.
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                Author and article information

                Contributors
                Ivan Urits: iurits@bidmc.harvard.edu
                Journal
                Journal ID (nlm-ta): Neurol Ther
                Journal ID (iso-abbrev): Neurol Ther
                Title: Neurology and Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 2193-8253
                ISSN (Electronic): 2193-6536
                Publication date (Electronic): 2 June 2020
                Publication date PMC-release: 2 June 2020
                Publication date Collection: December 2020
                Volume: 9
                Issue: 2
                Pages: 229-241
                Affiliations
                [1 ]Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
                [2 ]GRID grid.410396.9, ISNI 0000 0004 0430 4458, Department of Anesthesiology, , Mount Sinai Medical Center, ; Miami, FL USA
                [3 ]GRID grid.134563.6, ISNI 0000 0001 2168 186X, Department of Anesthesiology, , University of Arizona College of Medicine-Phoenix, ; Phoenix, AZ USA
                [4 ]GRID grid.254748.8, ISNI 0000 0004 1936 8876, Department of Anesthesiology, , Creighton University School of Medicine, ; Omaha, NE USA
                [5 ]Pain Management Centers of America, Paducah, KY USA
                [6 ]GRID grid.64337.35, ISNI 0000 0001 0662 7451, Department of Anesthesiology, , Louisiana State University Health Shreveport, ; Shreveport, LA USA
                [7 ]Envision Physician Services, Phoenix, AZ USA
                Author information
                http://orcid.org/0000-0002-3729-1900
                Article
                Publisher ID: 197
                DOI: 10.1007/s40120-020-00197-1
                PMC ID: 7606364
                PubMed ID: 32488840
                SO-VID: 00c92e25-8aa7-464e-a755-2f14cab25a21
                Copyright © © The Author(s) 2020
                History
                Date received : 17 April 2020
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                Keywords: gon,lon,nerve block,neuropathic pain,occipital neuralgia
                Data availability:
                Keywords: gon, lon, nerve block, neuropathic pain, occipital neuralgia

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