scholarly journals Persistent pain relief following a single injection of a local anesthetic for neuropathic abdominal wall and groin pain

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Monica L. Y. E. Jacobs ◽  
Marc R. M. Scheltinga ◽  
Rudi M. H. Roumen
Keyword(s):  
Pain Relief ◽  
Abdominal Wall ◽  
Local Anesthetic ◽  
Groin Pain ◽  
Pain Syndrome ◽  
Persistent Pain ◽  
Anesthetic Agent ◽  
Local Anesthetic Agent ◽  
Pain Syndromes

Abstract Objectives It is our experience that a small portion of patients with neuropathic abdominal wall pain syndromes such as the anterior cutaneous nerve entrapment syndrome (ACNES) have a long term beneficial response following just one single tender point injection (TPI) with a local anesthetic agent. This report focuses on the phenomenon of ongoing pain relief following a single local anesthetic injection in neuropathic abdominal wall and groin pain syndromes. Methods This report is an overview based on earlier studies from a center of expertise for neuropathic abdominal wall and groin pain syndromes. All studies on neuropathic abdominal wall and groin pain syndromes reporting on efficacy of a diagnostic TPI using a local anesthetic agent were included. Results A total of 10 studies including 834 patients fulfilled study criteria. Each of these 10 studies found that approximately 10% (range, 4–25%) of the cases experienced persistent pain relief after a single TPI with lidocaine 1%. Conclusions Persistent pain relief after a single TPI using a local anesthetic agent may be observed in approximately one of 10 patients suffering from neuropathic abdominal wall or groin pain syndromes. When a patient is suspected of having a neuropathic abdominal wall or groin pain syndrome, a single TPI using a local anesthetic agent should be administered as long term pain relief may occasionally occur.

Amitriptyline Neurotoxicity

2004 ◽  
Vol 100 (6) ◽  
pp. 1519-1525 ◽  
Author(s):  
Jean-Pierre Estebe ◽  
Robert R. Myers
Keyword(s):  
Nervous System ◽  
Sciatic Nerve ◽  
Local Anesthetic ◽  
Dose Range ◽  
Antidepressant Drug ◽  
Nerve Fibers ◽  
Anesthetic Agent ◽  
Sprague Dawley ◽  
Neurotoxic Effect ◽  
Local Anesthetic Agent

Background Amitriptyline is a tricyclic antidepressant drug used systemically for the management of neuropathic pain. Antidepressants, as a class of drugs with direct neurologic actions, are becoming widely used for the management of chronic pain, although their mechanisms are not entirely understood. Amitriptyline exerts potent effects on reuptake of norepinephrine and serotonin and blocks alpha 2A adrenoreceptors and N-methyl-D-aspartate receptors. Because amitriptyline is also a particularly potent blocker of sodium channels and voltage-gated potassium and calcium channels, it has been recommended as a long-acting local anesthetic agent. Unfortunately, amitriptyline has significant toxic side effects in the central nervous system and cardiovascular system that are dose-related to its systemic administration. Therefore, before amitriptyline can be used clinically as a local anesthetic agent, it should be thoroughly explored with respect to its direct neurotoxic effect in the peripheral nervous system. Methods The left sciatic nerve of Sprague-Dawley rats (12/ group) received a single topical amitriptyline dose of 0.625, 1.25, 2.5, or 5 mg; a saline group (n = 2) was used as control. Neuropathologic evaluations were conducted in separate animals (n = 4) 1, 3, and 7 days later. Results Amitriptyline topically applied in vivo to rat sciatic nerve causes a dose-related neurotoxic effect. Drug doses of 0.625-5 mg all caused Wallerian degeneration of peripheral nerve fibers, with the number of affected fibers and the severity of the injury directly related to the dose. Conclusion Because the effective local anesthetic dose is within this dose range, the authors strongly recommend that amitriptyline not be used as a local anesthetic agent.

scholarly journals Pain syndrome patterns and their characteristics in multiple sclerosis patients

2021 ◽  
Vol 27 (1-2) ◽  
pp. 36-45
Author(s):  
M.I. Bozhenko ◽  
Keyword(s):  
Multiple Sclerosis ◽  
Pain Syndrome ◽  
Persistent Pain ◽  
Pain Syndromes ◽  
Constant Pain ◽  
Average Pain ◽  
History Of ◽  
Multiple Sclerosis Patients ◽  
Syndrome Patterns ◽  
Paroxysmal Pain

Aim of the research is to analyze the patterns of pain syndromes and their characteristics in multiple sclerosis patients. Materials and Methods. A total of 104 multiple sclerosis patients complaining of pain during the last month were examined in Lviv Regional Multiple Sclerosis Center. We analyzed medical records, performed general medical and neurological examinations and compiled history of lifestyle, illness and pain. The VAS and PainDetect questionnaires were used to assess the characteristics of pain syndromes. The patients were asked to choose one of the 4 typical patterns of pain, which best described their feelings. Then the analysis of pain syndrome patterns and their characteristics was carried out. Results and Discussions. All 4 typical patterns of pain syndromes were registered in multiple sclerosis patients. However, only 26.92% of the participants experienced an intermittent pain pattern. The rest of patients suffered from patterns characterized by persistent pain. The evaluation of the patterns and their characteristics revealed typical features. The highest intensity of the severest and average pain during the last month was present in the patients suffering from constant pain with distinct attacks: 8.0 [7.0; 9.0] points (p<0.05) and 7.0 [5.0; 8.0] points (p<0.05), respectively. Persistent paroxysmal pain was more common in the multiple sclerosis patients with neuropathic pain (43.8±8.8% vs 20.4±5.8%, p<0.05). Irradiating pain is also characteristic to this pattern in 52.9±8.6% of patients (p<0.05). The head is the most common pain localization in the patients experiencing persistent pain with severe attacks - 82.4±9.2% of cases (p<0.05). Conclusions. Pain is a permanent symptom in a significant number of multiple sclerosis patients. It can have different patterns of progression. However, it has typical characteristics and their understanding will aid in the diagnosis, prognosis and treatment of pain syndromes in multiple sclerosis patients

Changes in management of patients with diseases of musculoskeletal system and joints

2021 ◽  
pp. 36-40
Author(s):  
A. L. Vertkin ◽  
A. N. Barinov ◽  
G. Yu. Knorring
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Severe Pain ◽  
Pain Syndrome ◽  
Cooperative Action ◽  
Pain Syndromes ◽  
Adequate Pain Relief ◽  
Inflammatory Drugs ◽  
Group B ◽  
Group B Vitamins

Pain syndrome accompanies the vast majority of diseases; therefore, the issues of adequate pain relief remain topical not only for urgent conditions, but also for everyday medical practice. Modern and changed in recent years approaches to the appointment of anesthetic therapy should take into account not only the pathogenetic mechanisms of the development of pain syndrome in a particular patient, but also the need to use drug combinations. This allows for the potentiation of the analgesic effect, reduction of effective dosages of individual drugs and minimization of side effects. In case of severe pain syndrome in the presence of signs of impaired nociception, neuropathic and muscle-fascial pain syndromes, the use of non-steroidal anti-inflammatory drugs in conjunction with group B vitamins is justified. The article considers the pathogenetic details of such a combination therapy, reveals the mechanisms of the cooperative action of the proposed combination of drugs.

DYCLONINE—A NEW LOCAL ANESTHETIC AGENT

1956 ◽  
Vol 17 (5) ◽  
pp. 648-652 ◽  
Author(s):  
Leroy C. Harris ◽  
John C. Parry ◽  
F. E. Greifenstein
Keyword(s):  
Local Anesthetic ◽  
Anesthetic Agent ◽  
Local Anesthetic Agent

Subdural Spread of Local Anesthetic Agent following Thoracic Paravertebral Block and Cannulation

2003 ◽  
Vol 98 (4) ◽  
pp. 1005-1007 ◽  
Author(s):  
Ignacio Garutti ◽  
Monica Hervias ◽  
Jose Maria Barrio ◽  
Fernando Fortea ◽  
Jesus de la Torre
Keyword(s):  
Local Anesthetic ◽  
Paravertebral Block ◽  
Anesthetic Agent ◽  
Thoracic Paravertebral Block ◽  
Local Anesthetic Agent

Cervical Intra-Articular Facet Injection: Computed Tomography

2016 ◽  
Author(s):  
Amaresh Vydyanathan ◽  
Karina Gritsenko ◽  
Samer N. Narouze ◽  
Allan L. Brook
Keyword(s):  
Pain Relief ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Facet Joint ◽  
Medial Branch ◽  
Nerve Blocks ◽  
Articular Facet ◽  
Short And Long Term ◽  
Joint Injections

Intra-articular facet joint injections commonly refer to the injection of a contrast media and local anesthetic solution, with or without corticosteroids, directly into the facet joint space. The purpose of this procedure is pain relief as well as to establish an etiological diagnosis for surgical interventions such as joint denervation or radiofrequency ablation. Medial branch block, or facet nerve block, refers to injection of local anesthetic and possible corticosteroids along the medial branch nerve supplying the facet joints. Cervical intra-articular and facet nerve block injections are often part of a work-up for general or focal neck pain, headaches, or cervical muscle spasms. There is limited evidence for short- and long-term pain relief with cervical intra-articular facet joint injections. Cervical medial branch nerve blocks with local anesthetics demonstrate moderate evidence for short- and long-term pain relief with repeat interventions, and strong evidence exists for long-term pain relief following cervical radiofrequency neurotomy.

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