Thermocoagulation of the Gasserian ganglion in patients with trigeminal neuropathy resistant to pharmacotherapy

Indication for thermocoagulation of the Gasserian ganglion is trigeminal neuralgia resistant to pharmacologic treatment, which either is not effective or cannot be applied due to its side effects. In Pain Clinic of Clinic of Anaesthesiology and Intensive Care in Warsaw in the period from July of 2008 to June of 2011 there were 31 thermocoagulation procedures performed in 19 patients. Age of the patients varied between 46 and 86 years. The time of symptoms was between 2 and 30 years and pain was of intermittent character and its intensity in NRS was between 8 and 10 points. Thermocogulation was performed on ambulatory basis but in conditions of an operating room. Image of the foramen ovale was received through proper positioning of the patients and adjustment of the X-ray C-arm. Location of the tip of the electrode was verified by the C-arm, sensory and motor stimulation and injection of a dye. Time of the procedure was 60 seconds. In 18 patients a decrease in pain lasted from 7 to 24 months was reached. For one patient data has been missing. In none of the patients no serious adverse effects were noted.Indication for thermocoagulation of the Gasserian ganglion is trigeminal neuralgia resistant to pharmacologic treatment, which either is not effective or cannot be applied due to its side effects. In Pain Clinic of Clinic of Anaesthesiology and Intensive Care in Warsaw in the period from July of 2008 to June of 2011 there were 31 thermocoagulation procedures performed in 19 patients. Age of the patients varied between 46 and 86 years. The time of symptoms was between 2 and 30 years and pain was of intermittent character and its intensity in NRS was between 8 and 10 points. Thermocogulation was performed on ambulatory basis but in conditions of an operating room. Image of the foramen ovale was received through proper positioning of the patients and adjustment of the X-ray C-arm. Location of the tip of the electrode was verified by the C-arm, sensory and motor stimulation and injection of a dye. Time of the procedure was 60 seconds. In 18 patients a decrease in pain lasted from 7 to 24 months was reached. For one patient data has been missing. In none of the patients no serious adverse effects were noted

Spastic paralysis after sustaining cervical spinal cord injury: 13 years on a baclofen pump - case report

Spasticity is a very troublesome symptom, which causes further deterioration in physical disability and in many cases precludes effective treatment. The aim of this paper is to recall different methods for treating spasticity, with particular consideration of the modern method of employing a baclofen pump with a patient who had suffered trauma to the cervical spinal cord.Spasticity is a very troublesome symptom, which causes further deterioration in physical disability and in many cases precludes effective treatment. The aim of this paper is to recall different methods for treating spasticity, with particular consideration of the modern method of employing a baclofen pump with a patient who had suffered trauma to the cervical spinal cord

Results of bilateral thoracoscopic splanchnicectomy in a patient with diabetic neuropathy of the coeliac plexus; reduction of 2,000 mg daily dose of morphine: a case report

We report the case of a 32-year-old patient with a long history of diabetes mellitus Type I complicated by coeliac plexus neuropathy. A strong pain syndrome of neuropathic type led to an addiction to parenterally applied morphine. The patient consumed 2,000 mg of intravenous or subcutaneous morphine per day. Thanks to the cooperation of three centres, the Pain Clinic at the Department of Anaesthesiology and Intensive Therapy of The Medical Centre of Postgraduate Education (CMKP) in Warsaw, the Department of Surgery CMKP in Warsaw, and the Pain Clinic and Palliative Care Clinic of Jagiellonian University Medical College (CMUJ) in Cracow, it was possible to stop the opioid intake completely.We report the case of a 32-year-old patient with a long history of diabetes mellitus Type I complicated by coeliac plexus neuropathy. A strong pain syndrome of neuropathic type led to an addiction to parenterally applied morphine. The patient consumed 2,000 mg of intravenous or subcutaneous morphine per day. Thanks to the cooperation of three centres, the Pain Clinic at the Department of Anaesthesiology and Intensive Therapy of The Medical Centre of Postgraduate Education (CMKP) in Warsaw, the Department of Surgery CMKP in Warsaw, and the Pain Clinic and Palliative Care Clinic of Jagiellonian University Medical College (CMUJ) in Cracow, it was possible to stop the opioid intake completely

Uraz rdzenia kręgowego w odcinku szyjnym kręgosłupa z porażeniem spastycznym - 13 lat pompy baklofenowej

Spastyczność jest bardzo dokuczliwym objawem, powodującym pogorszenie niepełnosprawności, a w wielu przypadkach uniemożliwiającym skuteczne leczenie. Celem niniejszej pracy jest przedstawienie różnych metod leczenia spastyczności, ze szczególnym uwzględnieniem nowoczesnych metod obejmujących zastosowanie pompy baklofenowej u pacjenta, który doznał urazu rdzenia kręgowego w odcinku szyjnym. Medycyna Paliatywna w Praktyce 2010; 4, 1: 30-3

5% lidocaine medicated plasters vs. sympathetic nerve blocks as a part of multimodal treatment strategy for the management of postherpetic neuralgia: A retrospective, consecutive, case-series study

Introduction 5% lidocaine medicated plasters (5% LMP) have been appointed as a first-line treatment for post-herpetic neuralgia (PHN), while formerly used sympathetic nerve blocks (SNBs) were recently denied their clinical efficacy. The aim of this study was to compare the results of PHN management with the use of SNBs and 5% LMP as a first-line treatment. Material and methods This study was designed as a retrospective, consecutive, case-series study. Data of 60 consecutive PHN patients with allodynia treated with the use of SNBs and 60 subsequent patients managed with 5% LMP were analyzed. Pain severity after 8 weeks was assessed to recognize the results of the implemented therapy, with numeric rating scale (NRS) score <3 or =3 considered a success. Additionally, the number of pain-free patients (NRS=0) after 8 weeks were identified in both groups and compared. Results The rate of failures in SNBs and 5% LMP group was similar (18.9% vs. 27.1% of poor treatment results, respectively), with the average change in NRS of 5.88±2.41 in nerve blocks and 5.01±1.67 in lidocaine group (p=0.02). Significant difference was also noted in the rates of pain-free patients: 20 patients (34.4%) treated with SNBs and 8 (13.5%) using 5% LMP were pain-free after 8 weeks of treatment. Conclusion It may be concluded that SNBs may still be considered useful in PHN management, as it appears that in some cases this mode of treatment may offer some advantages over 5% LMP

Termolezja zwoju Gassera u pacjentów z neuralgią trójdzielną oporną na farmakoterapię

Wskazaniem do termolezji zwoju Gassera jest neuralgia trójdzielna, oporna na leczenie farmakologiczne, występowanie działań niepożądanych lub powikłań uniemożliwiających prowadzenie skutecznej farmakoterapii. W Poradni Leczenia Bólu Kliniki Anestezjologii i Intensywnej Terapii w Warszawie w okresie od lipca 2008 roku do czerwca 2011 roku przeprowadzono 31 zabiegów termolezji zwoju Gassera u 19 pacjentów. Pacjenci poddani zabiegowi mieli od 46 do 86 lat. Czas trwania objawów bólowych w badanej grupie wynosił od 2 do 30 lat. Pacjenci zgłaszali ból o charakterze napadowym, którego natężenie wynosiło od 8 do 10 punktów w skali numerycznej Numerical Rating Scale (NRS). Zabiegi termolezji zwoju Gassera przeprowadzano w trybie ambulatoryjnym, w warunkach sali operacyjnej. Otwór owalny uwidoczniano po odpowiednim ułożeniu głowy pacjenta i ustawieniu ramienia C aparatu rentgenowskiego. Właściwe umiejscowienie końca elektrody czynnej weryfikowano przy pomocą aparatu RTG z ramieniem C, wykonując stymulację ruchową i czuciową, oraz podaniem kontrastu. Czas trwania lezji wynosił 60 sekund. U 18 pacjentów uzyskano całkowite ustąpienie dolegliwości bólowych, które utrzymywało się od 7 do 24 miesięcy. Danych dotyczących jednego pacjenta nie udało się uzyskać. U żadnego z pacjentów nie wystąpiły poważne działania niepożądane

Stan po obustronnej torakoskopowej splanchnicektomii z powodu neuropatii cukrzycowej splotu trzewnego. Odzwyczajenie od dawki dobowej morfiny 2000 mg

Opis przypadku dotyczy 32-letniej pacjentki z wieloletnią cukrzycą typu 1, powikłaną neuropatią splotu trzewnego. U chorej z powodu silnego zespołu bólowego o typie bólu neuropatycznego doszło w ciągu około 2 lat do uzależnienia od morfiny stosowanej pozajelitowo. Chora stosowała w postaci dożylnej lub podskórnej 2000 mg morfiny na dobę. Dzięki współpracy trzech ośrodków: Poradni Leczenia Bólu Kliniki Anestezjologii i Intensywnej Terapii CMKP w Warszawie, Kliniki Chirurgii CMKP w Warszawie i Kliniki Bólu i Opieki Paliatywnej CMUJ w Krakowie udało się u chorej całkowicie odstawić leki opioidowe. Było to możliwe po wcześniejszym zniesieniu dolegliwości bólowych zlokalizowanych w nadbrzuszu w następstwie zabiegu obustronnej torakoskopowej splanchnicektomii

Sympathetic nerve blocks for the management of postherpetic neuralgia – 19 years of pain clinic experience

Background: Sympathetic system involvement in postherpetic neuralgia (PHN) has been targeted using peripheral sympathetic nerve blocks for a number of years with variable efficacy. The aim of this report is to present the outcomes of PHN management with concomitant use of pharmacological treatment and sympathetic nerve blocks.Methods: We retrospectively evaluated clinical data on 563 patients with PHN symptoms treated in the pain clinic and identified cases in which sympathetic nerve blocks were implemented in the years 1992−2010. A Numeric Rating Scale was used as a pain severity assessment, with a reduction to values under 3 considered a positive therapy result. Three time intervals were considered: years 1992−1997 (I), 1998−2002 (II) and 2003−2010 (III).Results: In group I, 27% of patients had poor treatment results, while in group II, the failure rate dropped to 18%. The same 18% failure rate was observed in group III as well. Treatment introduced early yielded the best results, but there was no difference among groups with a similar duration from herpes zoster onset to treatment commencement in the time periods assessed; however, from 1998 onward, the same rate of poor outcomes was also noted in the groups who started the sympathetic blockade, which aided pain clinic treatment up to 3 months and between 3 and 6 months from the onset of herpes zoster.Conclusion: Major progress in the pharmacological treatment of PHN appears to be an obvious factor contributing to the overall improvement in PHN management (introduction of gabapentin). Nevertheless, safely administered regional anaesthesia techniques, although performed in a very similar manner for many years, appear to provide some support as part of a multimodal approach to PHN management.Background: Sympathetic system involvement in postherpetic neuralgia (PHN) has been targeted using peripheral sympathetic nerve blocks for a number of years with variable efficacy. The aim of this report is to present the outcomes of PHN management with concomitant use of pharmacological treatment and sympathetic nerve blocks.Methods: We retrospectively evaluated clinical data on 563 patients with PHN symptoms treated in the pain clinic and identified cases in which sympathetic nerve blocks were implemented in the years 1992−2010. A Numeric Rating Scale was used as a pain severity assessment, with a reduction to values under 3 considered a positive therapy result. Three time intervals were considered: years 1992−1997 (I), 1998−2002 (II) and 2003−2010 (III).Results: In group I, 27% of patients had poor treatment results, while in group II, the failure rate dropped to 18%. The same 18% failure rate was observed in group III as well. Treatment introduced early yielded the best results, but there was no difference among groups with a similar duration from herpes zoster onset to treatment commencement in the time periods assessed; however, from 1998 onward, the same rate of poor outcomes was also noted in the groups who started the sympathetic blockade, which aided pain clinic treatment up to 3 months and between 3 and 6 months from the onset of herpes zoster.Conclusion: Major progress in the pharmacological treatment of PHN appears to be an obvious factor contributing to the overall improvement in PHN management (introduction of gabapentin). Nevertheless, safely administered regional anaesthesia techniques, although performed in a very similar manner for many years, appear to provide some support as part of a multimodal approach to PHN management