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Kalladka M, Al-Azzawi O, Heir GM, Kodapala S, Nainan MT, Khan J. Hemicrania continua secondary to neurogenic paravertebral tumor- a case report. Scand J Pain 2022; 22:204-209. [PMID: 34432971 DOI: 10.1515/sjpain-2021-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where sympathetic dysfunction and autonomic dysfunction resulting in parasympathetic over activation with some evidence of sympathetic inhibition have been suggested as probable causes. However, cases of hemicrania continua secondary to sympathetic dysfunction due to neurogenic paravertebral tumor impinging on the sympathetic chain has not been previously reported. In this case, the probability of the sympathetic dysfunction was more likely based on the clinical features and management. CASE PRESENTATION A 23-year-old female presented with a chief complaint of right unilateral pain in the retro-bulbar, head and facial region for the past three years. An initial MRI of the brain was negative, whereas an MRI of the spine was advised to rule out a cervicogenic origin of the pain. The MRI revealed a well-defined mass lesion within right paravertebral region at T3 indicative of a neurogenic tumor. The patient was diagnosed with probable hemicrania continua secondary to neurogenic tumor impinging on adjacent sympathetic chain. A trial of indomethacin 75 mg/day was advised, which provided complete relief of the headache. The patient was referred to a neurologist for management of the neurogenic tumor. CONCLUSIONS Headache disorders may be secondary to pathologies and comprehensive evaluation and accurate diagnosis are essential. Knowledge of neuroanatomy is paramount to understand and explain underlying pathophysiological mechanisms. Multidisciplinary management is essential in complex orofacial cases.
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Affiliation(s)
- Mythili Kalladka
- Eastman Institute for Oral Health, Orofacial Pain and Temporomandibular Joint Disorders, Rochester, NY, USA
| | - Osamah Al-Azzawi
- Eastman Institute for Oral Health, Orofacial Pain and Temporomandibular Joint Disorders, Rochester, NY, USA
| | - Gary M Heir
- Program and Clinical Director Center for Temporomandibular, Disorders and Orofacial Pain Rutgers, School of Dental Medicine, Newark, NJ, USA
| | - Suresha Kodapala
- Department of Neurology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | | | - Junad Khan
- Eastman Institute for Oral Health, Orofacial Pain and Temporomandibular Joint Disorders, Rochester, NY, USA
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Retrospective Study on Ganglionic and Nerve Block Series as Therapeutic Option for Chronic Pain Patients with Refractory Neuropathic Pain. Pain Res Manag 2020; 2020:6042941. [PMID: 32774567 PMCID: PMC7399767 DOI: 10.1155/2020/6042941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 11/18/2022]
Abstract
Objective Current recommendations controversially discuss local infiltration techniques as specific treatment for refractory pain syndromes. Evidence of effectiveness remains inconclusive and local infiltration series are discussed as a therapeutic option in patients not responding to standard therapy. The aim of this study was to investigate the effectiveness of infiltration series with techniques such as sphenopalatine ganglion (SPG) block and ganglionic local opioid analgesia (GLOA) for the treatment of neuropathic pain in the head and neck area in a selected patient group. Methods In a retrospective clinical study, 4960 cases presenting to our university hospital outpatient pain clinic between 2009 and 2016 were screened. Altogether, 83 patients with neuropathic pain syndromes receiving local infiltration series were included. Numeric rating scale (NRS) scores before, during, and after infiltration series, comorbidity, and psychological assessment were evaluated. Results Maximum NRS before infiltration series was median 9 (IQR 8–10). During infiltration series, maximum NRS was reduced by mean 3.2 points (SD 3.3, p < 0.001) equaling a pain reduction of 41.0% (SD 40.4%). With infiltration series, mean pain reduction of at least 30% or 50% NRS was achieved in 54.2% or 44.6% of cases, respectively. In six percent of patients, increased pain intensity was noted. Initial improvement after the first infiltration was strongly associated with overall improvement throughout the series. Conclusion This study suggests a beneficial effect of local infiltration series as a treatment option for refractory neuropathic pain syndromes in the context of a multimodal approach. This effect is both significant and clinically relevant and therefore highlights the need for further randomized controlled trials.
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Jin F, Li XQ, Tan WF, Ma H, Fang B, Tian AY, Lu HW. Effects of ultrasound-guided stellate-ganglion block on sleep and regional cerebral oxygen saturation in patients undergoing breast cancer surgery: a randomized, controlled, double-blinded trial. J Clin Monit Comput 2018; 32:855-862. [PMID: 29043600 DOI: 10.1007/s10877-017-0074-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 10/11/2017] [Indexed: 01/01/2023]
Abstract
Numerous factors could contribute to sleep disturbances in women with breast cancer. We hypothesized that stellate ganglion block (SGB) during surgery would preserve sleep after surgery and increase intraoperative regional cerebral oxygen saturation (rSO2) on the blocked side in patients undergoing breast cancer surgery. A randomized, double-blinded, controlled trial was conducted at the First Hospital of China Medical University from January 2016 to September 2016. Ninety-six patients who underwent radical breast cancer surgery requiring general anaesthesia were randomly assigned to one of two study groups: a control group that received a saline SGB and a block group that received a 0.25% ropivacaine hydrochloride SGB. The primary outcome measure was the postoperative sleep profile, which was assessed using the bispectral index on the first postoperative night. The secondary outcome measure was the intraoperative rSO2, monitored was throughout surgery using near-infrared spectroscopy. A total of 91 female patients (mean age: 45 years; range 24-51 years) were included in the study. The duration of sleep was significantly increased by 66.3 min in the ropivacaine-SGB group compared with the saline-SGB group. No differences in rSO2 were observed on either the left or right side of the patients in either group 50 min after anaesthesia induction. We conclude that ropivacaine-SGB combined with general anaesthesia might increase the first postoperative sleep duration without influencing the intraoperative rSO2 in female patients undergoing elective breast cancer surgery. Clinical trials.gov identifier NCT02651519.
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Affiliation(s)
- Feng Jin
- Department of Anaesthesiology, The First Hospital of China Medical University, 155# Nanjingbei Street, Shenyang, China
| | - Xiao-Qian Li
- Department of Anaesthesiology, The First Hospital of China Medical University, 155# Nanjingbei Street, Shenyang, China
| | - Wen-Fei Tan
- Department of Anaesthesiology, The First Hospital of China Medical University, 155# Nanjingbei Street, Shenyang, China.
| | - Hong Ma
- Department of Anaesthesiology, The First Hospital of China Medical University, 155# Nanjingbei Street, Shenyang, China
| | - Bo Fang
- Department of Anaesthesiology, The First Hospital of China Medical University, 155# Nanjingbei Street, Shenyang, China
| | - A-Yong Tian
- Department of Anaesthesiology, The First Hospital of China Medical University, 155# Nanjingbei Street, Shenyang, China
| | - Huang-Wei Lu
- Department of Anaesthesiology, The First Hospital of China Medical University, 155# Nanjingbei Street, Shenyang, China
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Lee SH, Kim Y, Lim TY. Efficacy of sphenopalatine ganglion block in nasal mucosal headache presenting as facial pain. Cranio 2018; 38:128-130. [DOI: 10.1080/08869634.2018.1475859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngdeuk Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Young Lim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Is sinus disease the cause of my headaches? An update on sinus disease and headache. Curr Pain Headache Rep 2015; 18:418. [PMID: 24760488 DOI: 10.1007/s11916-014-0418-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The interplay between head pain caused by sinus disease and primary headaches is complex. Classification of secondary headaches, attributed to disorders of the nose or paranasal sinuses has been recently updated. New treatments including office- based procedures are emerging for patients with chronic sinusitis. This paper briefly reviews sinus disease and headache.
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Akbas M, Gunduz E, Sanli S, Yegin A. [Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain]. Rev Bras Anestesiol 2014; 66:50-4. [PMID: 25467885 DOI: 10.1016/j.bjan.2014.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/02/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE There are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. METHODS Infrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25-0.5ms pulse width was applied for sensory stimulation at frequencies from 50Hz to 1V. Paraesthesias were exposed at the roof of the nose at 0.5-0.7V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120s at a temperature of 42°C. RESULTS Pain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion-pulsed radiofrequency treatment. CONCLUSION Pulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.
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Affiliation(s)
- Mert Akbas
- Divisão de Algologia, Departamento de Anestesiologia, Faculdade de Medicina, Universidade Akdeniz, Antalya, Turquia.
| | - Emel Gunduz
- Departamento de Anestesiologia, Faculdade de Medicina, Universidade Akdeniz, Antalya, Turquia
| | - Suat Sanli
- Departamento de Anestesiologia, Faculdade de Medicina, Universidade Akdeniz, Antalya, Turquia
| | - Arif Yegin
- Divisão de Algologia, Departamento de Anestesiologia, Faculdade de Medicina, Universidade Akdeniz, Antalya, Turquia
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Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain. Braz J Anesthesiol 2014; 66:50-4. [PMID: 26768930 DOI: 10.1016/j.bjane.2014.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/02/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE There are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. METHODS Infrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25-0.5 ms pulse width was applied for sensory stimulation at frequencies from 50 Hz to 1 V. Paraesthesias were exposed at the roof of the nose at 0.5-0.7 V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2 Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120 s at a temperature of 42°C. RESULTS Pain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion-pulsed radiofrequency treatment. CONCLUSION Pulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.
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Noma N, Kamo H, Nakaya Y, Dezawa K, Young A, Khan J, Imamura Y. Stellate Ganglion Block as an Early Intervention in Sympathetically Maintained Headache and Orofacial Pain Caused by Temporal Arteritis. PAIN MEDICINE 2013; 14:392-7. [DOI: 10.1111/pme.12040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scientific Meeting of the Interventional Pain Special Interest Group of the British Pain Society: 8 September 2012 Radisson Blue Hotel, Manchester, UK. Br J Pain 2012. [DOI: 10.1177/2049463712468056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Peñarrocha-Diago M, Boronat A, Peñarrocha-Oltra D, Ata-Ali J, Bagan JV, Peñarrocha-Diago M. Clinical course of patients with episodic cluster headache treated with corticosteroids inproximity to the sphenopalatine ganglion: a preliminary study of 23 patients. Med Oral Patol Oral Cir Bucal 2012; 17:e477-82. [PMID: 22143727 PMCID: PMC3476098 DOI: 10.4317/medoral.17578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/03/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A study is made of the clinical course of patients with episodic cluster headache following the injection of corticosteroids in the proximity of the sphenopalatine ganglion of the affected side. STUDY DESIGN A retrospective observation study was made corresponding to the period between 2006 and 2010. Patients with episodic cluster headache received corticosteroid infiltrations in the vicinity of the sphenopalatine ganglion. Data were collected to assess the clinical course, quantifying pain intensity and quality of life. A total of 23 patients (11 women and 12 men) with a mean age of 50.4 years (range 25-65) were included. Forty percent of the patients had undergone dental extractions in the quadrant affected by the pain, before the development of episodic cluster headache, and 37.8% underwent extractions in the same quadrant after appearance of the headache. RESULTS Most of the patients suffered 1-3 attacks a day, with a duration of pain of between 31-90 minutes. The mean pain intensity score during the attacks at the time of the first visit was 8.8 (range 6-10), versus 5.4 (range 3-9) one week after the first corticosteroid injection. On the first visit, 86.9% of the patients reported unbearable pain, versus 21.7% after one week, and a single patient after one month. CONCLUSIONS The evolution of episodic cluster headache is unpredictable and variable, though corticosteroid administration clearly reduces the attacks and their duration.
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Ebbeling MB, Oomen KP, De Ru JA, Hordijk GJ, Bleys RL. Neurochemical Characterization of Pterygopalatine Ganglion Branches in Humans. Am J Rhinol Allergy 2012; 26:e40-5. [DOI: 10.2500/ajra.2012.26.3697] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Pterygopalatine ganglion (PPG) branches, seem to be involved in the pathophysiology of facial pain. The functions of these branches, including a recently discovered orbital branch, are not completely known but could be of clinical significance. This study was designed to characterize PPG branches through immunohistochemical stain and study their anatomy, specifically the orbital branches. Methods In a cadaver study of four specimens, the pterygopalatine fossa (PPF) was dissected out of its bony surroundings as a tissue block. Subsequently, cryostat sectioning of these blocks was performed. In one specimen the PPF was microscopically dissected. Recently discovered neural structures were identified, dissected out of the tissue block, and cryosectioned. All cryostat sectionings were immunohistochemically stained for protein gene product (PGP) 9.5, nitric oxide synthase (NOS), and tyrosine hydroxylase (TH). Results A recently discovered neural connection between the PPG and the ophthalmic nerve could be confirmed and classified as an orbital PPG branch. The connection stained throughout for PGP 9.5 and partially stained for NOS. In other orbital branches, both NOS and TH+ nerve fibers were found. The PPG contained NOS+ cells. TH labeling was also found in nerve fibers running through the PPG and the vidian nerve. Conclusion The recently discovered orbital PPG branch is of a mixed parasympathetic and sensory nature. In the other orbital branches, sympathetic fibers were shown as well. This knowledge may add to understanding the symptomatology and therapies of headache syndromes such as nerve block.
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Affiliation(s)
- Michelle B. Ebbeling
- Division of Surgical Specialties, Department of Anatomy, Central Military Hospital, the Netherlands
| | - Karin P. Oomen
- Division of Surgical Specialties, Department of Anatomy Otorhinolaryngology–Head and Neck Surgery, Central Military Hospital, the Netherlands
| | - Jacob A. De Ru
- Division of Otorhinolaryngology, University Medical Center Utrecht, Central Military Hospital, the Netherlands
| | - Gerrit J. Hordijk
- Division of Surgical Specialties, Department of Anatomy Otorhinolaryngology–Head and Neck Surgery, Central Military Hospital, the Netherlands
| | - Ronald L. Bleys
- Division of Surgical Specialties, Department of Anatomy, Central Military Hospital, the Netherlands
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Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A, Mazarakis A, Lappas D, Piagkos G, Johnson EO. The Pterygopalatine Ganglion and its Role in Various Pain Syndromes: From Anatomy to Clinical Practice. Pain Pract 2011; 12:399-412. [DOI: 10.1111/j.1533-2500.2011.00507.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Salvaggio I, Adducci E, Dell'Aquila L, Rinaldi S, Marini M, Zappia L, Mascaro A. Facial pain: a possible therapy with stellate ganglion block. PAIN MEDICINE 2009; 9:958-62. [PMID: 18950449 DOI: 10.1111/j.1526-4637.2008.00515.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of the present study is to verify the efficacy of stellate ganglion block (SGB) in the treatment of facial pain that can be found in different pathological syndromes, and also to examine whether the efficacy is dependent upon when this therapy is administered. PATIENTS Fifty patients (divided into two randomized groups) with facial pain caused by traumas, iatrogenic issues, herpes zoster, or neurological pathologies participated in this study. DESIGN AND INTERVENTIONS The first group (N = 25) was treated with SGB produced by 10 administrations of 10 mg of levobupivacaine given every other day, followed by one administration per month for 6 months thereafter. The second group was treated with the drugs tramadol 100 mg/day and gabapentin 1800 mg/day orally for 6 months; during the 7th month they were given SGB therapy using the same methodology as that described for the first group. RESULTS Before treatment, the mean visual analog scale (VAS) pain score for the first group was 8.89; after the 10th block treatment it was just 0.2, and it remained at that reduced level for the 6th and 12th months. Before treatment, the mean VAS pain score for the second group was 8.83; after the 20th day on medication it was reduced to 4.1, after 6 months it was 5.7 and after 12 months it was 4.9. CONCLUSIONS Our results indicate that patients must be treated with SGB therapy precociously to receive its full benefits.
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Affiliation(s)
- Ilaria Salvaggio
- Anaesthesiology and Intensive Care Institute, Catholic University, Medical School, Rome, Italy.
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Bayer E, Racz GB, Miles D, Heavner J. Sphenopalatine Ganglion Pulsed Radiofrequency Treatment in 30 Patients Suffering from Chronic Face and Head Pain. Pain Pract 2005; 5:223-7. [PMID: 17147584 DOI: 10.1111/j.1533-2500.2005.05314.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study evaluated the efficacy of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) treatment in patients suffering from chronic head and face pain. Thirty patients were observed from 4 to 52 months after PRF treatment. The primary efficacy measures were the reduction in oral medication use, including opioids, time-to-next-treatment modality for presenting symptoms, duration of pain relief, and the presence of residual symptoms. Secondary objectives included the evaluation of adverse effects and complications. All data were derived from patient charts, phone conversations, and clinical follow-up visits. Fourteen percent of respondents reported no pain relief, 21% had complete pain relief, and 65% of the patients reported mild to moderate pain relief from SPG-PRF treatment. Sixty-five percent of the respondents reported mild to moderate reduction in oral opioids. None of the patients developed significant infection, bleeding, hematoma formation, dysesthesia, or numbness of palate, maxilla, or posterior pharynx. A large-scale study of SPG-PRF for the treatment of face and head pain has not been previously reported. Our results suggest that a prospective, randomized, controlled trial study to confirm efficacy and safety of this novel treatment for chronic head and face pain is justified.
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Affiliation(s)
- Erin Bayer
- International Pain Institute, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Quevedo JP, Purgavie K, Platt H, Strax TE. Complex regional pain syndrome involving the lower extremity: A report of 2 cases of sphenopalatine block as a treatment option. Arch Phys Med Rehabil 2005; 86:335-7. [PMID: 15706564 DOI: 10.1016/j.apmr.2004.04.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report 2 cases of complex regional pain syndrome (CRPS) involving the lower extremity; in both, a sphenopalatine ganglion (SPG) block was performed as part of a pain management program. In the first case, a woman in her late twenties presented with CRPS in the left lower extremity that was inadequately controlled with typical oral medications. Sympathetic block of the extremity did not provide significant pain relief. However, a noninvasive sphenopalatine block with 4% tetracaine resulted in a 50% reduction in pain level. The patient was shown how to self-administer the sphenopalatine block and was provided with exercises and therapy to help improve her functional status. The second case involved a woman in her mid forties with CRPS in the right lower extremity that was partially controlled with oral medications. The patient experienced a 50% reduction in pain level when SPG block with 4% tetracaine was given. Further study is needed to determine the effects of SPG blocks on symptoms related to chronic regional pain syndrome.
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Affiliation(s)
- Jonathan P Quevedo
- Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, JFK Johnson Rehabilitation Institute, Edison, NJ, USA
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