BACKGROUND: Cervical spinal cord stimulation (SCS) has been used in selected patients with refractory headaches and neuropathic pain. However, overlapping conditions like cervicalgia, fibromyalgia, and inflammatory arthritis can result in persistent nonneuropathic pain that SCS may not adequately address.

CASE REPORT: We present the case of a 40-year-old woman with a history of cervicalgia, fibromyalgia, chronic myofascial pain, and inflammatory polyarthritis who underwent a cervical SCS placement with 2 leads ending at C2 for chronic headaches and neck pain. While the SCS provided excellent headache relief, the axial neck and trapezius facet joint pain persisted despite device optimization, medication management, pain psychology, and physical therapy.

CONCLUSIONS: Fluoroscopically guided cervical medial branch blocks provided immediate and clinically meaningful symptomatic relief through 1-month follow-up. This case highlights the potential role of cervical medial branch blocks in patients with persistent facet-mediated pain despite an otherwise successful SCS response.

KEYWORDS: Cervical facet joint pain; spinal cord stimulation; chronic neck pain; cervicogenic headache; interventional pain management