Ganglion Impar block improves neuropathic pain in coccygodynia: A preliminary report

Aim of the study To define the effectiveness of ganglion Impar block in improving neuropathic pain. Materials and methods Patients who had pain around the coccyx for more than three months and did not respond to conservative treatment were included in this study. All the patients underwent fluoroscopy guided transsacrococcygeal ganglion Impar block with injecting 3 mL of 0.5% bupivacaine, 2 mL saline, and 1 mL (40 mg) of methylprednisolone. Patients were evaluated with visual analog scale (VAS) for pain, Leeds assessment of neuropathic symptoms and signs scale (LANSS) for neuropathic pain, Beck depression Inventory (BDI) for mood and Short-form 12 (SF-12) for quality of life before, 1 month 3 months and 6 months after the injection. Patients’ painless sitting duration was also recorded. Results A total of 28 patients were included in the final analyses. VAS and LANSS scores improved significantly throughout the follow-up periods. BDI scores also improved while SF-12 scores did not show significant changes. Painless sitting period of the patients’ improved significantly. Conclusions Ganglion Impar block is effective in decreasing the neuropathic component of chronic coccygodynia. This improves painless sitting in patients but its reflections on quality of life is not clear

Hypothalamic-pituitary-adrenal axis function in traumatic spinal cord injury-related neuropathic pain: a case-control study

PurposeThis study aimed to investigate the hypothalamic-pituitary-adrenal (HPA) axis in spinal cord injury (SCI)-related neuropathic pain (NP) using dynamic adrenocorticotropic hormone (ACTH) stimulation tests.MethodsThis case-control study was conducted with 22 patients diagnosed with traumatic chronic spinal cord injury (15 with and 7 without neuropathic pain) and ten age- and sex-matched healthy control subjects. Collected data included socio-demographic variables, SCI characteristics, and level of NP using a numeric rating scale (NRS) and the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS). HPA axis function was measured via low-dose (1 mu g) and standard-dose (250 mu g) ACTH tests (LDT and SDT, respectively).ResultsNo significant differences existed regarding peak cortisol responses or area under the curve (AUC) of cortisol responses between the SCI patients with NP and healthy controls using LDT and SDT. In the SCI patients without pain, cortisol responses were significantly lower than those in the healthy controls for LDT and SDT. Peak cortisol and AUC responses of the LDT and SDT were positively correlated with NRS in SCI patients with NP.ConclusionsThis study demonstrated that, in chronic SCI patients with NP, basal cortisol levels are relatively higher compared to healthy controls, and that HPA axis can be activated with low- and standard-dose ACTH stimulation tests. Although NP following SCI was not significantly associated with hypo- or hypercortisolemia, either after low- or standard-dose ACTH stimulation test, the severity of NP during chronic SCI may be positively associated with HPA axis activity

Use of fluoroscopic-guided transsacral block for the treatment of iatrogenic post-injection sciatic neuropathy: Report of three cases

Post-injection sciatic neuropathy (PISN) from an inadvertent intramuscular injection in the gluteal region is a type of iatrogenic sciatic nerve injury. Patients with neuropathic pain following PISN frequently experience disability leading to restrictions in daily activities and pain, which may be resistant to conventional treatments and physiotherapy in some cases. To date, minimal invasive procedures for neuropathic pain have been performed with various medications at the site of lesion. Herein, we report three adult male cases with PISN-associated neuropathic pain who were resistant to conservative management and were treated with fluoroscopy-guided transsacral block

Efficacy of fluoroscopy-guided triple shoulder injection for older patients with nonspecific shoulder pain

Key Summary PointsAimThe study was to evaluate the effects of fluoroscopy-guided triple shoulder injection (i.e. injection into glenohumeral joint, subacromial space, and acromioclavicular joint) on pain and function in older patients with nonspecific shoulder pain.FindingsA significant improvement was detected in pain, and function at 3 and 12 weeks after injection compared with baseline.MessageFluoroscopy-guided triple shoulder injection offers a therapeutic option for older patients with nonspecific shoulder pain. AbstractPurposeNonspecific shoulder pain is a common complaint in older adults that impairs physical function by restricting the range of joint movement, and causing severe pain. The study evaluated the effects of fluoroscopy-guided triple shoulder injection [i.e., injection into glenohumeral (GH) joint, subacromial (SA) space, and acromioclavicular (AC) joint] on pain, function, and range of motion in older patients with nonspecific shoulder pain.MethodsA total of 43 patients who were aged 65years and older and diagnosed with nonspecific shoulder pain were included in this prospective, non-randomized clinical trial; 65.1% of the patients were female and mean age was 70.25.0. Under fluoroscopic guidance, a mixture of methylprednisolone and bupivacaine was injected into the GH joint, SA space and AC joint. Patients were evaluated as per the Numeric Rating Scale for Pain (NRS-Pain), the Shoulder Pain and Disability Index (SPADI), and the active range of motion (AROM) at baseline, and again at 3 and 12weeks after the injection.ResultsA statistically significant improvement was detected in NRS-Pain, SPADI, and AROM at 3 and 12weeks after injection compared with baseline. The change in SPADI score from baseline was higher than the minimal detectable change in 67.4% of patients at 12weeks. The SPADI score at baseline was positively correlated with the post-injection SPADI score at 3 and 12weeks.Conclusions In older patients with nonspecific shoulder pain, fluoroscopy-guided triple shoulder injection provides significant improvements in pain and physical function with low complication rates during the 12-week follow-up

The influence of coccygeal dynamic patterns on ganglion impar block treatment results in chronic coccygodynia

Objective: Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB