Peripheral Nerve Stimulation of the Occipital Nerve to Treat Postherpetic Neuralgia

Background: Herpes zoster infection and subsequent postherpetic neuralgia can cause chronic neuropathic pain. Patients who do not respond well to pharmacotherapy require therapeutic options that are typically more invasive; our goal was to minimize invasiveness.CasePresentation: We present a case of intractable postherpetic neuralgia refractory to conservative pharmacological treatment and multiple occipital nerve blocks, which was successfully treated using peripheral occipital nerve stimulation (ONS) with an external implantable pulse generator (IPG).Conclusion: For interventionalists, one of the technical difficulties during ONS placement involves tunneling leads through the high-risk and difficult anatomy of the posterior neck. Further complicating placement and increasing patient discomfort are the long leads required for internal IPG implantation. The most commonly cited complication is lead migration or lead breakage. This difficulty can be attenuated by using an external IPG, such as was used in this case. An external IPG makes the ONS procedure significantly less invasive and reduces trauma and discomfort for the patient.Key words: Peripheral nerve stimulation (PNS), occipital nerve, postherpetic neuralgia (PHN), occipital nerve stimulation (ONS), implantable pulse generator (IPG), external IPG