title: Successful treatment of occipital neuralgia with implantable peripheral nerve stimulation in a pacemaker-dependent patient.
abstract: BACKGROUND
  Peripheral nerve stimulation has been used to treat patients with occipital nerve-related chronic headaches who have been unsuccessful with less invasive therapeutic approaches. Patients with pacemaker-dependent cardiac conduction abnormalities require unique consideration prior to the implantation of peripheral nerve stimulators because the placement of the devices may lead to failure of the systems secondary to electromagnetic interference or crosstalk between the devices.
  
  
  METHODS
  An 86-year-old female who suffered from chronic right-sided cervicogenic headaches and neck pain had received only temporary relief from previous treatments. Additional comorbidities included longstanding pacemaker-dependent atrioventricular node conduction disease. Because the extent to which nerve stimulators electrically interact with pacemakers is unclear, we tunneled the leads to the lumbar region of the back and placed the generator on the contralateral side to the pacemaker to minimize the chance that the 2 devices would interfere. The patient has remained pain free for 1 year since implantation.
  
  
  CONCLUSIONS
  Although no current published trials evaluate the degree of interference between medical devices, case reports increasingly suggest that simultaneous implantation of a spinal cord stimulator and pacemaker is safe as long as precautions are taken and the devices are checked periodically, particularly when the devices are adjusted.
authors.affiliation: Department of Pain Management, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Gassan
authors.initials: G
authors.lastname: Chaiban
authors.affiliation: Department of Pain Management, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Reda
authors.initials: R
authors.lastname: Tolba
authors.affiliation: Department of Pain Management, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Hazem
authors.initials: H
authors.lastname: Eissa
authors.affiliation: Department of Pain Management, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Lesley Smallwood
authors.initials: LS
authors.lastname: Lirette
authors.affiliation: Department of Pain Management, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Almualim
authors.affiliation: Department of Psychiatry, Cleveland Clinic, Cleveland, OH.
authors.forename: Adham
authors.initials: A
authors.lastname: Malaty
authors.affiliation: Department of Pain Management, University of Toledo Medical Center, Toledo, OH.
authors.forename: Joseph
authors.initials: J
authors.lastname: Atallah
keywords: Implantable neurostimulators; neuralgia; pacemaker–artificial; transcutaneous electric nerve stimulation