Background and Aims Post-herpetic neuralgia (PHN) is a painful condition that presents after herpes zoster reactivation in the peripheral and central nervous system. When medical treatment fails, options are limited, and patients may suffer with chronic pain indefinitely. A man in his 80’s was referred to our clinic with a three-year history of right-sided posterior scalp and periauricular pain after herpes zoster infection presenting as Ramsay Hunt Syndrome. He rated the pain between 6-10 and averaging a 9 on a scale of 10 with distribution in the right occipital and periauricular areas.

Methods The patient was brought to the procedure suite, and, prior to the procedure, ultrasound guidance was used to visualize the right lesser occipital and greater auricular nerves. Ultrasound imaging identified the optimal needle path of the affected target nerves. Next, using a combined in-plane and out-of-plane technique (figure 1), a linear array electrode was advanced in close proximity to the right lesser occipital nerve and right greater auricular nerve.

Results The patient returned for lead removal on post-procedural day 65. He reported 90% improvement in the presence of his symptoms with pain averaging a 0 out of 10.

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Abstract EP235 Figure 1

Ultrasound guided needle placement

Conclusions PNS is an effective and safe option for the treatment of chronic pain, and we present a report of successful treatment of PHN in a particularly difficult anatomic distribution. PNS of the lesser occipital and greater auricular nerves is a novel treatment for PHN and shows promise as an effective, safe therapy when other treatment fails.