Supraorbital neuralgia has been identified as an infrequent cause of headache that may prove very difficult to control pharmacologically. Peripheral nerve stimulation using electrodes to stimulate the nerve segmentally responsible for the zone of pain may constitute a management alternative in such cases. We present the case of a patient with headache because of posttraumatic supraorbital neuralgia, refractory to medical treatment, with good analgesic control after peripheral nerve stimulation. Peripheral nerve stimulation may be considered a safe, reversible treatment for patients with headache secondary to supraorbital neuralgia who respond poorly to pharmacological treatment, thus avoiding irreversible alternatives such as surgery.
Spinal cord stimulation is an accepted therapy for the treatment of chronic ischemic pain and ulcer healing and to avoid amputation in patients with severe, nonrevascularisable peripheral occlusive arteriopathy, and specially in the subgroup of patients with Buerger disease. It should not only be considered as a last resort strategy for pain control, but as a valid therapeutic option to improve perfusion of the limbs in the initial stages of the disease, however larger studies still remain necessary.
Martorell ulcer is a specific disease entity characterized by multiple small homogeneous, symmetrical lesions, although single lesions are observed as well, most commonly located on the anterolateral aspect of the lower leg. The pain associated to these lesions is disproportionate to their size.Martorell ulcer designates a specific disease entity that occurs predominantly in middle-aged women with poorly controlled hypertension in the form of skin ulcers on the anterolateral aspect of the lower legs. The lesions initially appear as small, painful blisters which may or may not be associated with trauma. The pathophysiology of Martorell ulcer is assumed to be related to hypertension-induced arteriole changes in the dermis. The pain is often disproportionate, and the symptoms are not relieved by rest or elevation.Spinal cord stimulation (SCS) is an accepted evidence-based therapy for the treatment of chronic ischemic pain. Spinal cord stimulation is used as a therapeutic tool in the management of this disease not only for symptomatic pain control but also for accelerating the healing process through its effects on causal mechanisms. The beneficial effects of SCS when used to treat ischemic pain include pain relief, decreased infarction or ulcer size, decreased oxygen requirements, and increased claudication distance. Clinical and basic studies indicate that these beneficial effects are mainly associated with an increase or redistribution of blood flow to the ischemic area and/or normalization of the activity in the nervous system.We present the case of a 71-year-old woman diagnosed with Martorell ulcer in the acute phase of the disease. The patient was treated with SCS to achieve both pain relief and healing of the cutaneous ulcer.
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