Background: Epidural motor cortex stimulation (MCS) is an established neuromodulatory option for refractory neuropathic pain; however, structured data on long-term outcomes, stimulation dependency, and real-world device management remain limited, particularly in chronic neuropathic orofacial pain. Methods: This retrospective single-center cohort study included patients with refractory neuropathic orofacial pain treated with epidural MCS at a tertiary neurosurgical center. Clinical data were extracted from medical records and longitudinal follow-up documentation. Pain intensity was assessed using a unified 0–10 numerical rating scale (NRS/VAS) at baseline, best achieved response, and last follow-up. Responder status was defined at the last follow-up (≥50% pain reduction from baseline). Secondary outcomes included stimulation dependency during OFF periods, reprogramming burden, device-related events, and safety. Results: Ten patients (6 women, 4 men; mean age 61.5 ± 8.6 years) were followed for a mean of 7.6 ± 6.3 years (range 2–22 years), with 70% exceeding five years of follow-up. Baseline pain intensity (8.8 ± 0.4) decreased to 4.6 ± 0.8 at the best achieved response and remained lower at last follow-up (5.6 ± 0.9). At the last follow-up, eight patients (80%) were classified as partial responders (30–49% pain reduction), while two (20%) were classified as non-responders. Clinically relevant worsening during stimulator OFF periods occurred in 70% of patients. Reprogramming was required in all patients, and 60% underwent battery replacement. No clinically significant stimulation-related adverse effects were observed. Conclusions: Epidural MCS was associated with sustained pain reduction over extended follow-up. These findings support the interpretation of MCS as a chronic neuromodulatory therapy requiring ongoing stimulation, individualized programming, and long-term device management, contributing clinically relevant long-term evidence to the evolving role of neuromodulation in refractory chronic neuropathic pain.

Introduction: Spinal cord stimulation (SCS) is an established treatment for refractory neuropathic pain conditions, yet evidence for its effectiveness in spinal cord injury (SCI)-related neuropathic pain, particularly after decades of persistent symptoms, remains limited. It remains unclear whether unusually prolonged pain chronicity and established neurological deficits affect the potential for a meaningful response to neuromodulation. Case presentation: We report a 60-year-old man with chronic incomplete SCI, bilateral spastic paraparesis markedly more pronounced on the left, and severe chronic neuropathic pain following a gunshot-related spinal injury sustained in 1991. Retained metallic fragments were located at T12–L1; however, a formal neurological level of injury and AIS grade could not be reliably reconstructed because a complete contemporaneous ISNCSCI examination was unavailable. The longstanding bilateral lower-extremity pain phenotype was clinically consistent with below-level SCI neuropathic pain, although formal classification was limited by the absence of an ISNCSCI-defined neurological level. After more than three decades of persistent pain refractory to multimodal conservative treatment, permanent SCS was performed with two epidural leads positioned at T8–T9. Stimulation was predominantly DTM-based, supplemented by individualized tonic programming and later activation of closed-loop stimulation. Pain intensity decreased from 8/10 at baseline to 3/10 at 12 months and 2/10 at 24 months. This sustained response was accompanied by improvements in self-reported disability, neuropathic pain features, self-rated health, and psychological well-being, together with sustained discontinuation of pain-directed pharmacological therapy. No neurological deterioration or device-related complications occurred during the 24-month follow-up. Conclusion: This case demonstrates that a clinically meaningful and sustained multidimensional response to SCS can occur despite more than three decades of SCI-related neuropathic pain and established neurological impairment. Given the limited and heterogeneous evidence for SCS in this population, interpret this finding as an individual clinical observation supporting further investigation of neuromodulation in patients with longstanding SCI-related neuropathic pain, rather than as generalizable evidence for patient selection.

Introduction: Cervicotrigeminal convergence within the trigeminocervical complex (TCC) provides a neuroanatomical basis for referral of nociceptive input from upper cervical structures to trigeminal territories. However, clinical evidence linking occipital pain onset, trigeminal symptom propagation, and successful treatment with occipital nerve stimulation (ONS) remains limited. Case presentation: A 35-year-old woman developed persistent right-sided occipital, retroauricular, and upper cervical pain approximately eight years before presentation, which progressively spread into trigeminal territories. Multiple pharmacological therapies, greater occipital nerve neurolysis, microvascular decompression, and treatments targeting temporomandibular dysfunction failed to provide sustained relief. Following multidisciplinary evaluation, diagnostic greater occipital nerve (GON) blockade resulted in complete temporary resolution of pain. The patient subsequently underwent bilateral ONS, resulting in marked pain reduction (VAS 8–10/10 to 2/10), contraction of the pain distribution, discontinuation of opioid-containing analgesics, and sustained clinical improvement during follow-up. Conclusion: This case supports cervicotrigeminal convergence as a plausible mechanism underlying refractory facial pain following occipital pain onset. Complete temporary pain relief after diagnostic GON blockade and sustained improvement following ONS suggest that occipital neuromodulation may represent a therapeutic option in carefully selected patients.