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Occipital Nerve Stimulator Implantation Works on Hard-to-Manage Pain

by Dr Brian Klagges

Dr. Brian Klagges was recently appointed to the directorships of interventional pain management and of the interventional spine center at Elliot Hospital in Manchester, New Hampshire. A physician and anesthesiologist, Brian Klagges often performs minimally invasive surgeries that significantly reduce postoperative pain. One procedure he is familiar with is occipital nerve stimulator implantation (ONS).
This therapy is one of several meant for headaches that do not respond to other treatments. The stimulator is an example of neuromodulation, the use of electrical or chemical stimulation to reduce pain in various parts of the nervous system. Equipment for ONS consists of an electrode and a pulse generator, both of which are implanted surgically. The electrode is installed under the skin affected by the occipital nerves, and the generator is placed in a pocket under the skin of the back, abdomen, or chest.
Doctors test the system by inserting a trial electrode, powered by an external battery. The patient uses a pain diary to measure the trial system's effectiveness. If the patient reports reduced pain and increased quality of life, the permanent device is implanted. Both procedures allow for same-day discharge.
The Food and Drug Administration has approved this method for intractable occipital headache syndromes. However, its use in craniofacial pain and headaches outside of the syndrome has not been endorsed.
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