Neurolytic blockade of the obturator nerve in the treatment of idiopatic obturator neuralgia

Introduction. Idiopathic obturator neuralgia is a rare chronic pain condition. It consists of pain radiating from the obturator nerve territory to the inner thigh. However, the symptomatic obturator neuralgia is commonly caused by the obturator canal bowel hernia that causes painful compressive neuropathy in more than 85% of the cases. Case report. A 61-year-old female who underwent right femoral amputation due to the occlusion of the aortofemoral vascular graft, complained of the pain characterized by its localization in the inguinal region and anterointernal side of the right inner thigh. Computer tomography and MRI findings excluded obturator canal herniation or lumbar plexopathy. A diagnosis of the obturator neuralgia was confirmed by an analgesic block of the obturator nerve. Thereafter, the neurolitic blockade of the right obturator nerve was done. The complete pain relief was achieved. Pain relief was complete in three-month follow-up period. Conclusion. Neurolitic blockade is an efficacious method in treating chronic pain caused by the idiopathic obturator neuralgia.

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Intravenous cannula used for continuous intraoral mandibular nerve block in trigeminal neuralgia

BMJ Case Reports ◽

10.1136/bcr-2020-240368 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240368

Author(s):

Harriet Katharine Stringer ◽

Farzad Borumandi

Keyword(s):

Chronic Pain ◽

Pain Relief ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

Inferior Alveolar Nerve ◽

Oral Intake ◽

Nerve Blocks ◽

Chronic Pain Condition ◽

Intravenous Cannula ◽

The Third

Trigeminal neuralgia is a chronic pain condition affecting one or more distributions of the trigeminal nerve. Patients with this condition experience short, sharp, shooting pain attacks, which can progress to longer, more frequent durations. The pain is often difficult to control. We report of a man who was admitted with severe neuralgia of the third division of the trigeminal nerve. Talking and any oral intake triggered a severe agonising pain. The latter made the regular oral intake of analgesia challenging. The pain was temporarily controlled with frequent local anaesthesia (LA). Dental core trainees were performing regular inferior alveolar nerve blocks which significantly improved patients’ condition allowing him to communicate and have oral intake. Subsequently, a catheter was placed allowing for a continuous anaesthesia. The connecting tube of the cannula was then used by nursing staff to administer LA providing pain relief without the need of repeated intraoral injections.

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Spinal Cord Stimulation for Chronic Pain Relief: First Experience in Baltics

Acta Chirurgica Latviensis ◽

10.2478/v10163-012-0040-6 ◽

2011 ◽

Vol 11 (1) ◽

pp. 180-181

Author(s):

Iveta Golubovska ◽

Aleksejs Miscuks ◽

Vitolds Jurkevics ◽

Sarmite Skaida

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Pain Relief ◽

Low Income ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Neuropathic Pain Syndrome ◽

Patient Status ◽

First Case

Spinal Cord Stimulation for Chronic Pain Relief: First Experience in BalticsWe report the first case of spinal cord stimulator implantation in Baltics to patient with massive posttraumatic plexus lumbosacralis dxtr lesion, severe neuropathic pain syndrome and drug addiction problems. Follow-up time is 6 month since December 2011 and we have observed an obvious clinical and social improvement in patient status. Besides significant pain relief she has got employed and is tax payer instead of low-income person.

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Primary Orbital Myxoid Liposarcoma: A Case Report and Review of Literature

Asian Journal of Medical Sciences ◽

10.3126/ajms.v4i4.8311 ◽

2013 ◽

Vol 4 (4) ◽

pp. 28-32

Author(s):

Chen Niu ◽

Netra Rana ◽

Zhi Gang Min ◽

Ming Zhang

Keyword(s):

Medical Science ◽

Myxoid Liposarcoma ◽

Soft Tissue Tumors ◽

Lower Limbs ◽

Mri Findings ◽

One Year ◽

The Right ◽

Ct And Mri

Liposarcomas are common malignant soft-tissue tumors, which come from primitive mesenchymal cells and differentiate into adipose tissue. These tumors are more commonly found in lower limbs and retroperitoneal region but also reported in pharynx, lung, liver, digestive tract, diaphragm, as well as in the spermatic cord. We reported a case of primary orbital myxoid liposarcoma in a 20-year-old female patient presented with a painless proptosis of the right eye. The mass was pathologically diagnosed as a myxoid liposarcoma. The tumor recurred in 9 months after surgical intervention. The second surgery was performed and followed by postoperative local radiotherapy. No recurrence has been reported after one year of follow-up. We highlighted the role of CT and MRI findings in the tumor diagnosis and the importance of local radiotherapy after surgery. Asian Journal of Medical Science, Volume-4 (2013), Pages 28-32 DOI: http://dx.doi.org/10.3126/ajms.v4i4.8311

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Efficacy and Safety of Ultrasound-Guided Radiofrequency Treatment for Chronic Pain in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Pain Research and Management ◽

10.1155/2020/2537075 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Yuzhao Huang ◽

Qiufang Deng ◽

Liuqing Yang ◽

Jiahui Ma ◽

Ziyang Wang ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Pain Relief ◽

Knee Osteoarthritis ◽

Meta Analysis ◽

Knee Function ◽

Cochrane Library ◽

Efficacy And Safety ◽

Ultrasound Guided

Background. Knee osteoarthritis (KOA) is a common degenerative disease associated with joint dysfunction and pain. Ultrasound-guided radiofrequency (RF) may be a promising therapy in the treatment of chronic pain for KOA patients. Objective. To evaluate the efficacy and safety of ultrasound-guided RF treatment for chronic pain in patients with KOA. Design. A systematic review was conducted, and a meta-analysis was carried out when possible. Setting. We examined the studies evaluating the clinical efficiency of ultrasound-guided RF on chronic pain in KOA population. Method. A systematic review for the efficacy and safety of ultrasound-guided RF treatment for pain management of KOA patients was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) from the date of inception to February 2020, and a meta-analysis was conducted. The primary outcomes of pain intensity (visual analogue scale or numerical rating scale) and knee function [the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)] were evaluated from baseline to various follow-up times by random-effects model. Heterogeneity was assessed by I2 statistic and the potential sources of heterogeneity by subgroup and metaregression analyses, respectively. Results. Eight publications with 256 patients were included in the meta-analysis. RF could relieve pain with −4.196 of pooled mean difference and improve knee function by decreasing 23.155 points in WOMAC. Three patients had ecchymosis, two with hypoesthesia and one with numbness after the procedure, and improved within 6 months. Furthermore, study design and treatment target were the sources of heterogeneity by subgroup and metaregression analyses, accounting for 37% and 74% of variances, respectively. Target of genicular nerve achieved better pain relief than intra-articular or sciatic nerve. Sensitivity analysis showed that removal of any single study was unlikely to overturn the findings. Limitations. There were some limitations in the study. Firstly, the small number of relevant studies limited the confidence level of the meta-analysis. Also, the significant heterogeneity may not be explained due to the limited data. Secondly, the direct comparison of two different guidance methods (ultrasound vs. fluoroscopy) for RF therapy is lacking. In addition, the outcomes were blindly assessed in the meta-analysis from all studies according to evaluation of bias, which could affect the reality of the data. Finally, most of the studies only provided short follow-up times, so we could not analyze the long-term effectiveness of ultrasound-guided RF in the treatment of patients with KOA. Conclusions. Ultrasonography is an effective, safe, nonradiative, and easily applicable guidance method for RF in pain relief and functional improvement in KOA patients.

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Long-term outcome of multidisciplinary intervention of chronic non-cancer pain patients in a private setting

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2011.10.002 ◽

2012 ◽

Vol 3 (2) ◽

pp. 99-105 ◽

Cited By ~ 8

Author(s):

Villy Meineche-Schmidt ◽

Niels-Henrik Jensen ◽

Per Sjøgren

Keyword(s):

Chronic Pain ◽

Group Therapy ◽

Pain Clinic ◽

Secondary Outcome ◽

Individual Treatment ◽

Chronic Pain Condition ◽

Pain Condition ◽

Transfer Income

AbstractBackground and aimThe present study reports on chronic non-cancer patients who were referred to a private pain clinic, according to a waiting time guarantee and treated within one month from referral. Based on evaluation by members of the multidisciplinary staff at our pain clinic a pain management program could be offered individually or as group therapy.MethodsHealth related quality of life, psychometric tests, use of pain medication; socio-economic status and number of consultations in general practice were recorded at referral to the clinic and by postal questionnaires at follow-up 21 months later. The primary treatment outcome (treatment success) was defined as an improvement of at least 40 points in the physical component and/or the mental component of SF-36 from baseline to follow-up. Secondary outcome measures were changes in Beck’s Anxiety Inventory and Beck’s Depression Inventory, use of analgesics, work status and transfer income and number of consultations at the GP’s office due to the chronic pain condition.ResultsA total of 306 patients were included: 141 were treated individually and 165 were treated in groups. At follow-up, data were obtained from 189 patients (62%). Comparing baseline to follow-up data, 62% of group treated patients were treated successfully, compared with 41% of individually treated patients. Anxiety and depression were significantly improved in group treated patients but not in those treated individually. significantly more patients had work income (and less patients transfer income) among group treated, compared with individually treated. At follow-up use of antidepressants and anticonvulsants was increased whereas use of tranquilizers and strong opioids was decreased in all patients. Number of consultations at their GPs due to chronic pain was significantly reduced in all patients.ConclusionsMultidisciplinary treatment in a private pain clinic seems to have a long-term effect in relation to biological, psychological and social aspects of the chronic pain condition. Treatments based on group therapy may offer better results than individual treatment courses.ImplicationsThe effect of group therapy should be explored further.

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The place of S-ketamine in fibromyalgia treatment (ESKEFIB): study protocol for a prospective, single-center, double-blind, randomized, parallel-group, dose-escalation controlled trial

Trials ◽

10.1186/s13063-021-05814-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zuzana Javorcikova ◽

Michel Dangoisse ◽

Stéphane Nikis ◽

Jean-Paul Lechat ◽

Aline Gillain ◽

...

Keyword(s):

Chronic Pain ◽

Pain Relief ◽

Dose Escalation ◽

Primary Outcome ◽

High Dose ◽

Single Center ◽

Double Blind ◽

Link Type ◽

Parallel Group

Abstract Background Fibromyalgia is a chronic multidimensional pain disease with no curative treatment currently available. Its management relies on a multimodal approach involving pharmacologic and non-pharmacologic elements. Because a suggested factor in its etiology is a central sensitization phenomenon involving the N-methyl-D-aspartate receptor (NMDAR), NMDAR antagonists have been proposed as a treatment target. Ketamine and its levogyre form, S-ketamine, have been used to treat chronic pain for many years without consensus about their therapeutic efficiency. We aim to assess the efficacy of S-ketamine as a co-treatment for fibromyalgia. Methods This prospective, randomized, single-center, double-blind, parallel-group, dose-escalation trial will compare a co-treatment with S-ketamine (intervention) to a control treatment without S-ketamine (control). It will consist of two successive cohorts with 2:1 randomization ratio (S-ketamine at two different doses: control) with 105 participants in each cohort. The protocol follow-up time will be 12 weeks, including 3 visits for the treatment (week 0, week 2, and week 4) and 3 visits for follow-up (week 6, week 9, and week 12). Our primary outcome, pain relief and/or better patient function, will be assessed with the Brief Pain Inventory questionnaire. The statistical analysis will be performed on an intention-to-treat basis. If the primary outcome is reached at the end of follow-up in the first cohort with low-dose S-ketamine (0.2 mg/kg), the trial will end. If not, the trial will continue with the second cohort and high-dose S-ketamine (0.4 mg/kg). Discussion The challenge of our trial is the inclusion of a large number of participants in comparison to other trials involving ketamine or S-ketamine infusions for chronic pain management. The originality of our protocol is to include functionality in addition to pain relief as a primary outcome because these two endpoints are not linked in a linear way. For some patients, functional status is more important than pain relief. Trial registration EudraCT reference: 2020-000473-25, ClinicalTrials.gov: NCT04436250, first posted June 18, 2020; last updated July 21, 2020. Protocol version 2.2 issued on September 30, 2020, after a revision by the ethics committee. https://clinicaltrials.gov/ct2/show/NCT04436250

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Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials

BMJ ◽

10.1136/bmj.n1034 ◽

2021 ◽

pp. n1034 ◽

Cited By ~ 3

Author(s):

Li Wang ◽

Patrick J Hong ◽

Curtis May ◽

Yasir Rehman ◽

Yvgeniy Oparin ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Clinical Trials ◽

Pain Relief ◽

Physical Functioning ◽

Meta Analysis ◽

Medical Cannabis ◽

Increased Risk ◽

Small Improvement

Abstract Objective To determine the benefits and harms of medical cannabis and cannabinoids for chronic pain. Design Systematic review and meta-analysis. Data sources MEDLINE, EMBASE, AMED, PsycInfo, CENTRAL, CINAHL, PubMed, Web of Science, Cannabis-Med, Epistemonikos, and trial registries up to January 2021. Study selection Randomised clinical trials of medical cannabis or cannabinoids versus any non-cannabis control for chronic pain at ≥1 month follow-up. Data extraction and synthesis Paired reviewers independently assessed risk of bias and extracted data. We performed random-effects models meta-analyses and used GRADE to assess the certainty of evidence. Results A total of 32 trials with 5174 adult patients were included, 29 of which compared medical cannabis or cannabinoids with placebo. Medical cannabis was administered orally (n=30) or topically (n=2). Clinical populations included chronic non-cancer pain (n=28) and cancer related pain (n=4). Length of follow-up ranged from 1 to 5.5 months. Compared with placebo, non-inhaled medical cannabis probably results in a small increase in the proportion of patients experiencing at least the minimally important difference (MID) of 1 cm (on a 10 cm visual analogue scale (VAS)) in pain relief (modelled risk difference (RD) of 10% (95% confidence interval 5% to 15%), based on a weighted mean difference (WMD) of −0.50 cm (95% CI −0.75 to −0.25 cm, moderate certainty)). Medical cannabis taken orally results in a very small improvement in physical functioning (4% modelled RD (0.1% to 8%) for achieving at least the MID of 10 points on the 100-point SF-36 physical functioning scale, WMD of 1.67 points (0.03 to 3.31, high certainty)), and a small improvement in sleep quality (6% modelled RD (2% to 9%) for achieving at least the MID of 1 cm on a 10 cm VAS, WMD of −0.35 cm (−0.55 to −0.14 cm, high certainty)). Medical cannabis taken orally does not improve emotional, role, or social functioning (high certainty). Moderate certainty evidence shows that medical cannabis taken orally probably results in a small increased risk of transient cognitive impairment (RD 2% (0.1% to 6%)), vomiting (RD 3% (0.4% to 6%)), drowsiness (RD 5% (2% to 8%)), impaired attention (RD 3% (1% to 8%)), and nausea (RD 5% (2% to 8%)), but not diarrhoea; while high certainty evidence shows greater increased risk of dizziness (RD 9% (5% to 14%)) for trials with <3 months follow-up versus RD 28% (18% to 43%) for trials with ≥3 months follow-up; interaction test P=0.003; moderate credibility of subgroup effect). Conclusions Moderate to high certainty evidence shows that non-inhaled medical cannabis or cannabinoids results in a small to very small improvement in pain relief, physical functioning, and sleep quality among patients with chronic pain, along with several transient adverse side effects, compared with placebo. The accompanying BMJ Rapid Recommendation provides contextualised guidance based on this body of evidence. Systematic review registration https://osf.io/3pwn2

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Efficacy and Safety of 10 kHz Spinal Cord Stimulation for the Treatment of Chronic Pain: A Systematic Review and Narrative Synthesis of Real-World Retrospective Studies

Biomedicines ◽

10.3390/biomedicines9020180 ◽

2021 ◽

Vol 9 (2) ◽

pp. 180

Author(s):

Ganesan Baranidharan ◽

Deborah Edgar ◽

Beatrice Bretherton ◽

Tracey Crowther ◽

Abdul-Ghaaliq Lalkhen ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Chronic Pain ◽

Pain Relief ◽

Real World ◽

Spinal Cord Stimulation ◽

Retrospective Studies ◽

Incidence Rates ◽

Efficacy And Safety

10 kHz spinal cord stimulation (SCS) is increasingly utilized globally to treat chronic pain syndromes. Real-world evidence complementing randomized controlled trials supporting its use, has accumulated over the last decade. This systematic review aims to summarize the retrospective literature with reference to the efficacy and safety of 10 kHz SCS. We performed a systematic literature search of PubMed between 1 January 2009 and 21 August 2020 for English-language retrospective studies of ≥3 human subjects implanted with a Senza® 10 kHz SCS system and followed-up for ≥3 months. Two independent reviewers screened titles/abstracts of 327 studies and 46 full-text manuscripts. In total, 16 articles were eligible for inclusion; 15 reported effectiveness outcomes and 11 presented safety outcomes. Follow-up duration ranged from 6–34 months. Mean pain relief was >50% in most studies, regardless of follow-up duration. Responder rates ranged from 67–100% at ≤12 months follow-up, and from 46–76% thereafter. 32–71% of patients decreased opioid or nonopioid analgesia intake. Complication incidence rates were consistent with other published SCS literature. Findings suggest 10 kHz SCS provides safe and durable pain relief in pragmatic populations of chronic pain patients. Furthermore, it may decrease opioid requirements, highlighting the key role 10 kHz SCS can play in the medium-term management of chronic pain.

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Obturator Nerve Entrapment

Neurosurgery ◽

10.1227/01.neu.0000279743.45801.7e ◽

2007 ◽

Vol 61 (1) ◽

pp. E175-E175 ◽

Cited By ~ 22

Author(s):

Jérôme Rigaud ◽

Jean-Jacques Labat ◽

Thibault Riant ◽

Olivier Bouchot ◽

Roger Robert

Keyword(s):

Laparoscopic Approach ◽

Obturator Nerve ◽

Nerve Entrapment ◽

Computer Assisted ◽

Computer Assisted Tomography ◽

Internal Side ◽

Analgesic Block ◽

First Time ◽

Obturator Neuralgia ◽

Nerve Entrapment Syndrome

Abstract OBJECTIVE Obturator neuralgia consists of pain radiating from the obturator nerve territory to the inner thigh. METHODS We report a case of idiopathic obturator neuralgia resulting from compression of the obturator nerve in the obturator canal, causing a case of nerve entrapment syndrome. The pain was characterized by its localization in the inguinal region and anterointernal side of the thigh, going down to the internal side of the knee. It was worse when standing or in a monopodal stance. Walking caused pain and a limp. RESULTS The diagnosis was confirmed by an analgesic block. The analgesic was infiltrated using a posterior approach and computer-assisted tomography, allowing the quality and specificity of the infiltration to be judged. CONCLUSION We describe, for the first time, a treatment of obturator neuralgia by a minimally invasive laparoscopic approach. This involved an obturator nerve neurolysis and section of the internal obturator muscle and the obturator membrane.

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What Is the Appropriate Acupuncture Treatment Schedule for Chronic Pain? Review and Analysis of Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2019/5281039 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Yan-Jiao Chen ◽

Cai-Tao Chen ◽

Jia-Yuan Liu ◽

Gabriel Shimizu Bassi ◽

Yong-Qing Yang

Keyword(s):

Chronic Pain ◽

Pain Relief ◽

Randomized Controlled Trials ◽

Acupuncture Treatment ◽

Frequency Effect ◽

Controlled Trials ◽

Treatment Schedule ◽

Randomized Controlled ◽

Relief Rate

Background. Acupuncture is widely used for the treatment of chronic pain. Different protocols of acupuncture practice exist and lack agreement on the optimal schedule of acupuncture treatment. Objective. To review the appropriate acupuncture treatment schedule for chronic pain. Methods. Embase, Pubmed, Cochrane Central Register of Controlled Trials, and reference lists were searched from 2009 to 2018 to identify randomized controlled trials of acupuncture for chronic pain conditions. We collected factors of treatment schedule (D, duration of each treatment session; N, number of treatment sessions; T, total duration of treatment in weeks) from each of the trials, and the linear regression analysis with real pain relief rate (both treatment and follow-up) was performed. Furthermore, we recommend the concept of “DOSE” and frequency (F) to evaluate the dose and frequency effect of acupuncture. Results. Twenty-four trials with a total number of 3461 patients met the inclusion criteria. Of these, data from 23 studies were available for analysis. Firstly, the results showed that follow-up pain relief rate was decreased slightly with the increase of the duration of each session and DOSE (r=-0.3414 and r=-0.3246, respectively), but those two factors had no correlation with the pain relief rate after treatment. Secondly, it showed that either lower frequency with 2 sessions/week and higher frequency greater than 2 sessions/week or DOSE of 30 mins/week can achieve higher pain relief rate after treatment. Thirdly, we found the rate of pain relief remained at a high level greater than 20% up to 18 weeks after the treatment, and then it dropped sharply below 10% with the follow-up extended. A positive relationship was found between study score and pain relief both in treatment and follow-up (r=0.4654 and r=0.3046, respectively). Conclusions. The effect of acupuncture varies greatly with the different schedules of acupuncture, so it is necessary to review and choose the appropriate schedule. Although the current work is based on a limited number of trials, the findings suggest that acupuncture has a dose and frequency effect presenting within a certain range, which would have considerable implications for the design and interpretation of clinical trials. More high-quality randomized controlled trials on acupuncture schedule research were needed for providing more definitive evidence.

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