Relief of Trigeminal Anesthesia Dolorosa with Cervical Cord Stimulation: A Case Report

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Anesthesia dolorosa is a troublesome complication following the treatment of trigeminal neuralgia. The authors successfully treated a patient with anesthesia dolorosa by permanent placement of a Spinal Cord Stimulation (SCS) system at the upper cervical epidural space. A 52-year-old woman with a history of left-sided facial pain affecting the maxillary and mandibular divisions had undergone retrogasserian trigeminal nerve block with anhydrous glycerol. Soon after treatment, her left face became symptomatic consistent with anesthesia dolorosa. Various treatments, including analgesics and stellate ganglion block, had been attempted for the treatment of her pain with no relief. As an alternative treatment, high cervical epidural SCS was performed. The "PISCES Quad" electrode was placed at her C2/3 level left of midline, under fluoroscopic control. After a few seconds of stimulation, she noticed alleviation of left facial pain and her left eyelid opened completely. She subsequently lowered her dose of carbamazepine (Tegretol) by using 30-minute Spinal Cord Stimulation 3 times a day. SCS-induced increases in norepinephrine and glycine in the cerebrospinal fluid suggests that activation of inhibitory system is the mechanism of pain relief.
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