A case of pulsed radiofrequency lesioning for occipital neuralgia.
OBJECTIVE
This report describes a case where pulsed radiofrequency lesioning (RFL) of the greater occipital nerve (GON) offered a valuable and safe treatment for the management of greater occipital neuralgia. The case is considered in relation to a review of the medical literature on greater occipital neuralgia and RFL interventions.


METHODS
A 62-year-old man with a 43-year history of left suboccipital pain underwent pulsed RFL of the left GON (20-millisecond bursts at intervals of 0.5 second for 4 minutes at 42 degrees C) after failing to achieve substantial analgesia with naproxen, a transcutaneous electrical nerve stimulator (TENS) unit and a greater occipital nerve blockade (GONB) utilizing local anesthetic and steroid. After obtaining 4 months of 70% pain relief, pulsed RFL was repeated and resulted in an additional 5 months of 70% pain relief.


CONCLUSIONS
Pulsed RFL of the GON is an alternative to continuous RFL with the proposed advantage of mitigating pain, as in continuous RFL, but without the potential risk of causing deafferentation pain. While placebo and other nonspecific analgesic effects cannot be ruled out, the apparent safety profile and potential efficacy of pulsed RFL suggests it may be a compelling option to consider before irreversible neuroablative therapies are applied.
Navani
Annu
A
Bay Area Pain Center, Los Gatos, California, USA. navani@yahoo.com
Mahajan
Gagan
G
Kreis
Paul
P
Fishman
Scott M
SM
D000344:Afferent Pathways / Q000503:physiopathology / Q000528:radiation effects / Q000601:surgery; D000698:Analgesia / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D000700:Analgesics / Q000627:therapeutic use; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D003714:Denervation / Q000295:instrumentation / Q000379:methods / Q000639:trends; D004566:Electrodes / Q000592:standards; D020773:Headache Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000150:complications / Q000503:physiopathology; D009437:Neuralgia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D009619:Nociceptors / Q000503:physiopathology / Q000528:radiation effects; D009777:Occipital Bone; D013127:Spinal Nerves / Q000503:physiopathology / Q000528:radiation effects / Q000601:surgery*; D016896:Treatment Outcome
D000700:Analgesics