Portable Percutanous Electrode Nerve Stimulation as a Home-Based Therapy for Trigeminal Neuralgia, a Case Report

INTRODUCTION Trigeminal neuralgia is a painful condition characterized by intense and recurrent episodes of facial pain. Various therapeutic options have been explored, including Percutaneous Electrical Nerve Stimulation (PENS) at the emergence points of the affected branches of the trigeminal nerve. The possibility of performing the treatment at home using PENS devices allows for long-term, non-invasive pain management with few or no side effects. MATERIALS AND METHODS A 67-year-old woman presented for consultation due to a severe neuralgia experienced in the second and third branches of the trigeminal nerve scoring her pain as a NRS 6/10. Her medical history includes depression under treatment with mirtazapine 15 mg/day. In 2006, she underwent extraction of an impacted upper right third molar and one month after she developed neuralgia in the maxillary and mandibula branches on the right side. In 2016, she underwent microvascular decompression for marked neurovascular conflict, which resolved the symptoms but left a burning sensation exacerbated by chewing, oral hygiene, and speech. Maxillofacial evaluation did not reveal any pathological conditions explaining this symptomatology. Pharmacological management attempts over the years were unsuccessful due to persistence of symptoms or significant side effects from medications (pregabalin, carbamazepine, duloxetine). Two trials of pulsed radiofrequency (PRF) on the emergence of the trigeminal nerve were carried out (2020 and 2023) achieving about 60% of pain relief each time but symptoms gradually recurred in the following months. An adjunctive therapy was prescribed, including B-group vitamins, alpha-lipoic acid, and Palmitoylethanolamide (PEA). In January 2025 follow-up visit, patient reported persistent neuropathy and difficulties with speech and chewing, despite the absence of pain paroxysms. Medical therapy with duloxetine 30 mg was started, and the patient underwent a PENS session with percutaneous electrode arrays (Biowave PENS Monopolar), initially at the right cheekbone (with paresthesias appearing at 8% intensity and increasing to 27%) and then at the right mental region (paresthesias starting at 6% and gradually increasing to 25%). RESULTS During follow-up visit in March 2025, the patient reported a clear clinical benefit, with about 80% pain relief within the first ten days after the PENS session and almost complete disappearance of paresthesias in the trigeminal nerve territory. She repeated the treatment in April 2025 in our centre and she was advised to continue medical therapy with duloxetine 30 mg/day. Due to the efficacy of PENS treatment on her pain management she continues to perform cyclic PENS treatments at home with the portable PENS device with benefits, now scoring pain as a NRS 1/10. CONCLUSIONS PENS can become a key non-invasive treatment of refractory trigeminal neuralgias unresponsive to medication and invasive procedures and the possibility to undergo this treatment at home by using PENS portable device makes it a valid tool in the long-term management of this painful condition.