Successful Treatment of Occipital Neuralgia with Implantable Peripheral Nerve Stimulation in a Pacemaker-Dependent Patient

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.

Case Report 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.

Conclusion 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.