Pain practice : the official journal of World Institute of Pain
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Approximately 5% of the patients referred to outpatient pain clinics suffer thoracic pain. Thoracic pain in this article is limited to thoracic radicular pain and pain originating from the thoracic facet joints. Thoracic radicular pain is characterized by radiating pain in the localized area of a nervus intercostalis. ⋯ However, extensive skills are required to perform this procedure above the level of Th7. This treatment should take place in specialized centers. For thoracic facet pain, radiofrequency treatment of the ramus medialis of the thoracic rami dorsales is recommended (2 C+).
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Case Reports
Peripheral nerve field stimulation for intractable post-thoracotomy scar pain not relieved by conventional treatment.
Peripheral nerve field stimulation (PNFS) is being applied in individual cases where conventional treatments have failed to control pain localized to limited dermatomal distribution. We applied PNFS for unrelieved post-thoracotomy scar pain. Although spinal cord stimulation may have resulted in good coverage in the same dermatomal distribution, we chose the more peripheral approach to minimize the risk of complications, avoiding the potential neurologic sequelae associated with stimulation of the spinal cord. In summary, PNFS was effective in relieving post-thoractomy pain refractory to conventional pain management suggesting great potential of PNFS as a treatment option for chronic surgical-scar pain.
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Needle orientations for lumbar and cervical facet injection were measured in cadavers and compared with facet angles measured on magnetic resonance images (MRIs). ⋯ Knowledge of the quantitative anatomy of the facets may help improve clinical diagnosis and treatment. These data also may aid in constructing more realistic computer simulations.
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Report the successful use of stellate ganglion blocks (SGBs) in two patients experiencing symptoms of post-traumatic stress disorder (PTSD). ⋯ Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications. blacksquare, square, filled.