Combined Supraorbital (SONS) and Occipital Nerve Stimulation (ONS) for Intractable Post-Herpetic Neuralgia (P7.317)

Objective: Peripheral Nerve Stimulation is an effective treatment for refractory and chronic post-herpetic neuralgia.We detail a case of a patient suicidal with incapacitating, supraorbital PHN that had proven refractory to all commonly available therapies. Background: Post-herpetic neuralgia (PHN) is a chronic painful condition that follows upon acute herpes zoster (HZ) in over 60% of patients over the age of 60.1 In the US it is the most common cause of suicide in chronic pain patients over the age of 70.2 Initial studies on Supraorbital nerve stimulation SONS treatment of VI PHN report encouraging, but variable. Methods: Several years prior to presentation, a 64-year-old female developed PHN over the right forehead. When the severe pain (VAS 9/10) ultimately proved refractory to an extensive course of therapy, she became functionally incapacitated, and over the previous two years -- bedridden. Following a full evaluation, including trial stimulator, a combined occipital nerve stimulator and supraorbital nerve stimulator ONS-SONS system was implanted. Results: The day after implant the patient reported complete pain relief. and 6 weeks post implantation, she continues nearly pain free off medications and has returned to normal daily activities. Conclusions: While initial studies have documented SONS effectiveness for some patients with VI PHN3-5, this report is the first to describe incremental responsiveness to combined SONS-ONS. Disclosure: Dr. Bulger has nothing to disclose. Dr. Conidi has nothing to disclose. Dr. Reed has nothing to disclose.