Implantable Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain: A Systematic Review and Meta-Analysis

Objectives: Implantable peripheral nerve stimulation has been increasingly used to treat neuropathic pain. This neuromodulation strategy may be an alternative option for intractable trigeminal neuropathic pain; however, evidence for this treatment approach remains limited. A systematic review was conducted to identify studies of patients that underwent peripheral nerve stimulation implantation for trigeminal neuropathic pain.

Materials and methods: Databases including, PubMed, EMBASE, and Cochrane Library were searched up to October 5, 2020. The primary outcomes were changes in pain scores and response rates of neuromodulation therapy. A random effects model was used for meta-analysis. Subgroup analysis was performed to examine the source of heterogeneity.

Results: Thirteen studies including 221 participants were evaluated. The estimated response rate of neuromodulation treatment was 61.3% (95% CI: 44.4-75.9%, I² = 70.733%, p < 0.0001) at the last follow-up. The overall reduction in pain scores was 2.363 (95% CI: 1.408-3.319, I² = 85.723%, p < 0.0001). Subgroup analysis further confirmed that stimulation target (peripheral branch vs. trigeminal ganglion vs. trigeminal nerve root) contributed the heterogeneity across enrolled studies. Better clinical outcome was associated with stimulation of the trigeminal peripheral branch (p < 0.0001).

Conclusion: Peripheral nerve stimulation may be a promising approach in the management of trigeminal neuropathic pain, especially for patients intractable to conventional therapy.