Doreen Heath is an 80 year old lady who 6 years ago had a dental extraction. For two years the area remained numb then after this she developed excruciating neuropathic pain. She describes this pain as ‘totally unbearable’.

Doreen had a series of 4 local anaesthetic injections into the gum which were effective for several hours each. She now sucks anaesthetic lozengers, uses bonjella and anaesthetic patches at night and takes gabapentin regularly, all with little effect.

Doreen’s pain consultant decided to try PENS therapy. A 20mm PENS Probe was placed across the mental nerve through the oral mucosa - this was in the premolar region of the mandible. The 25 minute procedure was commenced.

Following the first procedure Doreen experience 11 days where she had almost no pain – ‘just a prickle where to probe had been’. Unfortunately the pain returned after this and was as extreme as before.

The procedure was repeated. This time Doreen had 7 days total relief and discontinued use of the lozengers, pads and bonjella. Following this the pain has returned but is much more bearable. If she wears the aneasthetic pads at night the pain remains at bay until late in the day.

Mrs Heath states ‘the pain is so much easier now and I feel I can cope’. Her Consultant plans to repeat the treatment.

PENS is a minimally invasive diagnostic therapy, which enables the physician to determine whether a patient is likely to benefit from an implanted stimulation device, although for some patients it may also provide ongoing pain management, thereby avoiding the need for more invasive therapies, with their attendant risks. There are also patient like Doreen for whom an implanted device is not appropriate and in these cases PENS therapy offers an alternative where other less invasive or pharmacological modalities have failed.

Chronic pain following dental extraction

PERCUTANEOUS ELECTRICAL NERVE STIMULATION (PENS) THERAPY FOR REFRACTORY PRIMARY HEADACHE DISORDERS

Trigemino-Cervical Neuropathic Pain Relieved by Serially Repeated Peripheral Nerve Field Stimulation

Dr Michael Vagg presents PENS at INS Perth

Algotec