Interventional Treatment of Neuropathic Pain

2018 ◽  
pp. 53-62
Author(s):  
Jiang Wu ◽  
Jianguo Cheng
Keyword(s):  
Neuropathic Pain ◽  
Scientific Evidence ◽  
Pain Syndrome ◽  
Cervical Radiculopathy ◽  
Interventional Treatment ◽  
Trigeminal Neuropathy ◽  
Sympathetically Maintained Pain ◽  
Peripheral Compression ◽  
Ablative Procedures ◽  
Interventional Therapies

Neuropathic pain has been reported to be highly prevalent, severely disabling, and often refractory to pharmacological and noninterventional conservative treatment. There is an emerging body of exciting evidence to support interventional therapies in selected refractory neuropathic pain states, although more randomized controlled trials or comparative effective trials are needed. This chapter updates the scientific evidence in support of the efficacy of neural blockade techniques and neural ablative procedures in neuropathic pain states, including peripheral compression or trauma-related neuropathic pain, herpes zoster and postherpetic neuralgia (PHN), lumbosacral and cervical radiculopathy, sympathetically maintained pain, complex regional pain syndrome (CRPS), trigeminal neuralgia and trigeminal neuropathy, and painful diabetic polyneuropathies.

Postmastectomy Neuropathic Pain

2018 ◽  
Author(s):  
Heena Pranav ◽  
Dalia H. Elmofty
Keyword(s):  
Neuropathic Pain ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Interventional Treatment ◽  
Evidence Based ◽  
Detailed History ◽  
Multiple Domains ◽  
Based Medicine ◽  
Pharmacologic Agents

Neuropathic pain can burden patients in multiple domains. It is a complex pain syndrome that remains difficult to treat. Detailed history and physical examination would reveal patients with neuropathic conditions complaining of burning, shocklike pain. There are a variety of neuropathic pain conditions that can be considered in a differential diagnosis. Because patients with neuropathic pain fail to obtain satisfactory relief from pharmacologic agents alone, a multidisciplinary approach that includes preventative and interventional options is recommended. Interventional treatment options may offer relief to patients with refractory neuropathic pain. Success in the treatment of neuropathic pain depends on evidence-based medicine and individualized patient care.

Complex Regional Pain Syndrome

2017 ◽  
Author(s):  
Jenna L. Walters
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Functional Restoration ◽  
Sympathetically Maintained Pain ◽  
Pain Medications ◽  
And Function ◽  
Interventional Therapies ◽  
Neuropathic Pain Condition

Complex regional pain syndrome (CRPS) is a neuropathic pain condition classified as type 1 and type 2. The two classifications are distinguished by the presence of documented nerve injury in CRPS type 2. The symptoms of CRPS, including cold, blue, and painful extremities, are believed to occur from vasoconstriction caused by sympathetic dysfunction. Treatment in CRPS focuses on targeting neuropathic and sympathetically maintained pain. Traditional antineuropathic pain medications include membrane stabilizers and serotonin and norepinephrine reuptake inhibitors. Corticosteroids and nonsteroidals target the inflammatory process present in the initial stages of CRPS. Bone resorption has been treated with calcium-modulating drugs. Interventional therapies include sympathetic blockade of the affected extremity, spinal cord stimulation, and intrathecal drug delivery. All these therapies have been implemented in an effort to facilitate functional restoration of the affected limb. Physical and occupational therapies have demonstrated some of the most significant improvements in pain, mobility, and function.

scholarly journals Interventional treatment for neuropathic pain due to combined cervical radiculopathy and carpal tunnel syndrome: a case report

2017 ◽  
Vol 5 (4) ◽  
pp. 414-418 ◽  
Author(s):  
Simone Vigneri ◽  
Gianfranco Sindaco ◽  
Matteo Zanella ◽  
Elisabetta Sette ◽  
Valeria Tugnoli ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Cervical Radiculopathy ◽  
Interventional Treatment ◽  
Tunnel Syndrome

Comparative Analysis: The State of Colorado Study, Part II

2004 ◽  
Vol 9 (2) ◽  
pp. 1-16
Author(s):  
Christopher R. Brigham ◽  
Kathryn Mueller ◽  
Douglas Van Zet ◽  
Debra J. Northrup ◽  
Edward B. Whitney ◽  
...  
Keyword(s):  
Daily Living ◽  
Scientific Evidence ◽  
Pain Syndrome ◽  
Evidence Based ◽  
Clinical Assessments ◽  
Physician Judgment ◽  
History Of ◽  
Key Terms ◽  
Causation Analysis ◽  
Work Interference

Abstract [Continued from the January/February 2004 issue of The Guides Newsletter.] To understand discrepancies in reviewers’ ratings of impairments based on different editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), users can usefully study the history of the revisions as successive editions attempted to provide a comprehensive, valid, reliable, unbiased, and evidence-based system. Some shortcomings of earlier editions have been addressed in the AMA Guides, Fifth Edition, but problems remain with each edition, largely because of the limited scientific evidence available. In the context of the history of the different editions of the AMA Guides and their development, the authors discuss and contextualize a number of key terms and principles including the following: definitions of impairment and normal; activities of daily living; maximum medical improvement; impairment percentages; conversion of regional impairments; combining impairments; pain and other subjective complaints; physician judgment; and causation analysis; finally, the authors note that impairment is not synonymous with disability or work interference. The AMA Guides, Fifth Edition, contrasts impairment evaluations and independent medical evaluations (this was not done in previous editions) and discusses impairment evaluations, rules for evaluations, and report standards. Upper extremity and lower extremity impairment evaluations are discussed in terms of clinical assessments and rating processes, analyzing important changes between editions and problematic areas (eg, complex regional pain syndrome).

Pain Syndrome, Markers of Bone Metabolism in Patients with Osteoarthritis, Approaches to Drug Therapy and the Impact of Obesity

2016 ◽  
pp. 26-35
Author(s):  
Oleksandr Kuryata ◽  
Anna Cherkasova
Keyword(s):  
Neuropathic Pain ◽  
Bone Metabolism ◽  
Clinical Efficacy ◽  
Functional Ability ◽  
Analgesic Effect ◽  
Pain Syndrome ◽  
Knee Joints ◽  
Osteocalcin Level ◽  
Positive Effects ◽  
The Impact

The objective: to assess the nature of pain in patients with osteoarthritis, the impact of obesity on the clinical efficacy of treatment of osteoarthritis (OA) and dynamics of bone metabolism markers. Patients and methods. The research included 150 patients with OA, who were divided into two groups, according to the receiving therapy. Patients of the main group – received diacerein (drug «Flexirin» PC «Kyiv Vitamin Factory») and patients of control group – received only nonsteroidal anti1inflammatory drugs (NSAIDs). Results. The prevalence of neuropathic pain component in patients with OA was 64,7%, among which 80,7% use NSAIDs as an analgesic therapy. Obesity in patients with OA was associated with significantly higher levels of pain from the side of knee joints and higher degree of stiffness according to WOMAC index. The results of the study demonstrated a direct moderate correlation (R = 0,49; p = 0,04) between PICP level and the severity of pain at physical load from the side of hands and hip joints. The therapy by diacerein within 3 months resulted in a reliable decrease of pain syndrome intensity from the side of all articular zones, unlike to isolated NSAIDs use, where a reliable analgesic effect was demonstrated only from the side of knee joints. Obesity in patients with OA led to a significant decrease in clinical efficacy of therapy in point of functional status of the joints. Conclusions. Neuropathic pain is quite common among patients with OA, which at the same time is associated with the lack of patient’s awareness about possible risks during NSAID’s use. Medical treatment by diacerein (drug “Flexirin”) causes stability of osteocalcin level, in contrast to the isolated NSAIDs use, where priority changes have been demonstrated against osteocalcin level decrease. The use of diacerein also resulted to additional positive effects from the side of zonal prevalence of analgesic effect and improving of functional ability of joints. Obesity in patients with OA was associated with a reliable increase of pain level intensity from the side of knee joints and the higher degree of functional limitation, causing at the same time, reduction of clinical efficacy of therapy in point of achieving analgesic effect and improving functional ability of joints.

First experience with chronic epidural spinal cord stimulation in Khanty-Mansi autonomous okrug — clinical observations

2021 ◽  
Vol LIII (2) ◽  
pp. 94-100
Author(s):  
Olga A. Bondarenko ◽  
Gaspar V. Gavrilov ◽  
Vadim A. Padurets ◽  
Roman V. Kasich
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Chronic Neuropathic Pain ◽  
Neuropathic Pain Syndrome ◽  
Epidural Stimulation ◽  
Cord Injury ◽  
Epidural Spinal Cord Stimulation ◽  
And Migration

Purpose of the work. The article is devoted to the first experience of epidural stimulation in the Khanty-Mansiysk Autonomous Okrug at the budgetary institution Surgut Clinical Trauma Hospital. Clinical examples are presented for two main indications for the application of this technique (disease of the operated spine, a consequence of spinal cord injury in combination with chronic neuropathic pain syndrome). Research methods. An assessment of the intensity of pain syndrome was given according to a visual analogue scale, the Pain Detect questionnaire; indicators of anxiety, depression on the HADS scale; quality of life according to the Oswestry questionnaire for a follow-up period of 6-12 months in patients with chronic epidural stimulation. Results. A positive assessment of the action during test neurostimulation was 63.3% (38 patients). Of the established permanent systems, a good result was achieved and persisted for 12 months or more in 96% (24 patients). It was necessary to change the stimulation parameters in 13% (3 patients). Revision of permanent systems was performed in 20% (5 patients), due to the progression of the degenerative-dystrophic process of the spine, damage and migration of system elements. Conclusions. Chronic epidural spinal cord stimulation has established itself as a personalized, highly effective, minimally invasive and safe method of treating chronic neuropathic pain syndromes. Multicomponent corrective action is of scientific interest and requires further study.

scholarly journals Spinal Cord Electrical Stimulation for Refractory Angina Treatment

2017 ◽  
Vol 38 (04) ◽  
pp. 272-278
Author(s):  
Gustavo Veloso Lages ◽  
Jose Oswaldo Oliveira Júnior
Keyword(s):  
Cardiovascular Disease ◽  
Spinal Cord ◽  
Neuropathic Pain ◽  
Electrical Stimulation ◽  
Visceral Pain ◽  
Pain Syndrome ◽  
Refractory Angina ◽  
Family Disruption ◽  
Appropriate Treatment ◽  
Absence From Work

AbstractCardiovascular disease (CVD) is the main cause of death worldwide, including in Brazil. Angina pectoris is a challenging disease because its clinical manifestation is not always related to the degree of obstruction. Visceral pain from any source can be totally disabling. It influences all aspects of the life of a patient and it can be one of the main causes of absence from work and of family disruption. Spinal cord electrical stimulation (SCES) has been traditionally applied for the treatment of neuropathic pain, with good to excellent results. Visceral pain syndrome can be as debilitating and disabling as somatic or neuropathic pain; however, there seems to be a lack of consensus on the appropriate treatment and strategies for these disorders. The major difference of SCES for visceral pain, compared to postlaminectomy syndrome or to regional complex syndrome, is the number of stimulated dermatomes. In most viscera, the somatotopic arrangement has two to four medullar levels, sometimes requiring laterality. After reviewing the literature, we have concluded that SCES is now a viable, low-risk option with satisfactory results for the treatment of neuropathic and visceral pain; therefore, it can be used in refractory angina after the failure of standard therapy. However, further studies are required to increase the application and efficacy of this procedure in the clinical practice.

scholarly journals Treatment of Type 1 Complex Regional Pain Syndrome in 14 Years Old Child

2014 ◽  
Vol 21 (4) ◽  
pp. 79-82
Author(s):  
V. N Merkulov ◽  
A. I Dorokhin ◽  
A. I Krupatkin ◽  
M. V Merkulov ◽  
M. A Avakova
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Hand Injury ◽  
Psychological Status ◽  
Interventional Treatment ◽  
Bolus Administration ◽  
Right Hand ◽  
Foot Injury ◽  
The Right

Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.

scholarly journals Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

2017 ◽  
Vol 7 (2) ◽  
pp. 68-79 ◽  
Author(s):  
Bruno Camporeze ◽  
Renata Faria Simm ◽  
Iracema Araújo Estevão ◽  
Luis Roberto Mathias Junior ◽  
Paulo Henrique Pires de Aguiar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Cost Effectiveness ◽  
Literature Review ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Cost Effective ◽  
Medical Conditions ◽  
Reduction Of Pain ◽  
Bibliographic Search

Introduction: The spinal cord stimulation (SCS) has been described as a valuable neuromodulating procedure in the management of chronic and medically untreated neuropathic pain. Although, many studies have discussed the use of this technique, a question still remains regarding its efficacy in different medical conditions with different etiology in the long term. The aim of this paper is to discuss the risks, complications, cost-effectiveness and results of SCS in patients affected by chronic neuropathic pain based on the comprehensive literature review. Methods: Bibliographic search of references from 1950 to 2016 using the databases MEDLINE, LILACS, SciELO, PubMed, and applied language as selection criteria, choosing preferably recent articles written in Portuguese, Spanish or English. Results: Based on literature review, SCS is a safe, reversible, adjustable and nondestructive surgical procedure demonstrating a significant effect in the reduction of pain intensity and improvement in quality of life in these patients. Furthermore, in spite of the initial high cost to its application, SCS has been associated with lower rates of complications and high rates of cost-effectiveness when compared to standard therapies. Conclusion: Although used in medical conditions with different etiology, the procedure is still an effective and a cost-effective approach to neuropathic pain, mainly in patients affected by failed back pain syndrome (FBSS) and complex regional pain syndrome (CRPS).

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