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This abstract was published in the
10th World Congress On Pain
August 17-22, 2002, San Diego, California,
USA
International Association For The Study Of
Pain
IASP Press
NERVE BLOCKS FOR
NEUROPATHIC PAIN
Hooshang Hooshmand
Masood Hashmi
Eric M. Phillips
(SPON. H. Hooshmand)
Neurological Associates Pain Management
Center
Vero Beach, Florida 32960 USA
Abstract Number:638-P272
Introduction:
Sympathetic
ganglion blocks are the standard nerve blocks for neuropathic pain. However, these blocks
are not consistently successful [1 ,
2 , 3 , 4 , 5 ] According to Bonica, in the hands of
experts, these blocks are technically successful in no more than 75% of patients [1]. Such blocks usually last for a short
period of time (from hours to days). As such, these blocks are more diagnostic than
therapeutic.
Methods: Comparative study of the
diagnostic and analgesic values of nerve blocks was done. Four groups of 100 patients were
studied for the efficacy of sympathetic, epidural, regional (BIER), and plexus blocks. The
regional temperature was measured with Bales Scientific Infrared Imaging Thermography.
Results: Sympathetic nerve blocks: These
nerve blocks were effective in the first few months post- injury lasting an average of 11
days. The technical success of sympathetic blocks was rated at 72%. The success rate of
warming up of the extremity and pain relief was reduced by an average of 11±2 days in 41%
of patients. This is in contrast to the other types of blocks lasting more than nine weeks
(Table).
Epidural blocks containing Depo-Medrol® were successful in 89%
of patients.
The regional BIER blocks showed an average success rate of 32%.
The brachial plexus blocks showed 63% success in regards to
analgesia and hyperthermia.
Conclusion: The sympathetic
nerve blocks are more diagnostic than therapeutic in nature. Epidural, regional, and
plexus blocks containing corticosteroids provide more effective and longer lasting pain
relief.
Keywords: Nerve Blocks,
Sympathetic Blocks, Neuropathic Pain, Regional Blocks, Plexus Blocks, Bier Blocks
Table
Comparison of Nerve Blocks
Type of Nerve
Block |
Duration of
Pain Relief |
Sympathetic Ganglion
Block |
11 ± 2 days |
Epidural Steroid Block |
9 ± 5 weeks |
Regional Bier Block |
2 ± 1 weeks |
Brachial Plexus Block |
8 ± 2 weeks |
References:
1. Bonica JJ: The Management of
Pain. Lea & Feibger Philadelphia. 1990; Vol. 1: p 229.
2.Carr DB, Cepeda MS, Lau J:
What is the evidence for the therapeutic role of local anesthetic sympathetic blockade in
RSD or causalgia? An attempted meta-analysis [abstract] Eighth world congress on pain,
Vancouver, August 17-22 1996., Seattle: IASP Press . 1996; 406.
3.
Hooshmand, H, Hashmi, M, Phillips, EM: Infrared Thermal Imaging
As A Tool In Pain Management- An 11 Year study", Part II: Clinical Applications,
Thermology International. Vol 11: no 3, August 2001.
4. Kozin F: Reflex sympathetic dystrophy: a
review. Clin Exp Rheumatol. 1992; 10: 401-9.
5. Schott GD: Interrupting the
sympathetic outflow in causalgia and reflex sympathetic dystrophy. A futile procedure for
many patients. BMJ. 1998; 316: 792-3.
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