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This abstract was published in the
10th World Congress On Pain
August 17-22, 2002, San Diego, California,
USA
International Association For The Study Of
Pain
IASP Press
NERVE BLOCKS
FOR NEUROPATHIC PAIN
Hooshang
Hooshmand
Masood Hashmi
Eric M. Phillips
(SPON. H. Hooshmand)
Neurological Associates Pain Management
Center
Vero Beach, Florida 32960 USA
Abstract Number:638-P272
Introduction:
Sympathetic ganglion blocks are the standard nerve
blocks for neuropathic pain. However, these blocks are not consistently successful [1, 2,
3, 4, 5 ].
According to Bonica, in the hands of experts, these blocks are technically successful in
no more than 75% of patients [1].
Such blocks usually last for a short period of time (from hours to days). As such, these
blocks are more diagnostic than therapeutic.
Methods:
Comparative study of the diagnostic and analgesic
values of nerve blocks was done. Four groups of 100 patients were studied for the efficacy
of sympathetic, epidural, regional (BIER), and plexus blocks. The regional temperature was
measured with Bales Scientific Infrared Imaging Thermography.
Results: Sympathetic
nerve blocks: These nerve blocks were effective in the first few months post- injury
lasting an average of 11 days. The technical success of sympathetic blocks was rated at
72%. The success rate of warming up of the extremity and pain relief was reduced by an
average of 11±2 days in 41% of patients. This is in contrast to the other types of blocks
lasting more than nine weeks (Table).
Epidural blocks containing Depo-Medrol® were successful in 89%
of patients.
The regional BIER blocks showed an average success rate of 32%.
The brachial plexus blocks showed 63% success in regards to
analgesia and hyperthermia.
Conclusion:
The sympathetic nerve blocks are more diagnostic than
therapeutic in nature. Epidural, regional, and plexus blocks containing corticosteroids
provide more effective and longer lasting pain relief.
Keywords:
Nerve Blocks, Sympathetic Blocks, Neuropathic Pain,
Regional Blocks, Plexus Blocks, Bier Blocks
Table
Comparison of Nerve Blocks
Type of Nerve Block |
Duration of Pain Relief |
Sympathetic
Ganglion Block |
11 ± 2 days |
Epidural
Steroid Block |
9 ± 5 weeks |
Regional
Bier Block |
2 ± 1 weeks |
Brachial
Plexus Block |
8 ± 2 weeks |
References:
1. Bonica JJ: The Management of Pain. Lea &
Feibger Philadelphia. 1990; Vol. 1: p 229.
2. Carr DB, Cepeda MS, Lau J: What is the
evidence for the therapeutic role of local anesthetic sympathetic blockade in RSD or
causalgia? An attempted meta-analysis [abstract] Eighth world congress on pain, Vancouver,
August 17-22 1996., Seattle: IASP Press . 1996; 406.
3. Hooshmand,
H, Hashmi, M, Phillips, EM: Infrared Thermal Imaging As A Tool In Pain Management- An 11
Year study", Part II: Clinical Applications, Thermology International. Vol 11: no 3,
August 2001.
4. Kozin F: Reflex sympathetic dystrophy: a
review. Clin Exp Rheumatol. 1992; 10: 401-9.
5. Schott GD: Interrupting the sympathetic
outflow in causalgia and reflex sympathetic dystrophy. A futile procedure for many
patients. BMJ. 1998; 316: 792-3.
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