Journal on Recent Advances in Pain

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2019 | September-December | Volume 5 | Issue 3

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EDITORIAL

Chinmoy Roy

Preprocedural Checklist: Equally Important for “Pain Procedures” Editorial

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:2] [Pages No:73 - 74]

Keywords: Checklist, Guidelines, Pain procedure, Policy

   DOI: 10.5005/jp-journals-10046-0150  |  Open Access |  How to cite  | 

Abstract

Checklists are designed to reduce errors and ensure consistency and completeness in carrying out a duty. It compensates for potential limits of human memory and attention. World Health Organization Surgical Safety Checklist demonstrated significant reductions in both morbidity and mortality with checklist implementation. Surgery checklist and anesthesia checklist are already in use. But any specific globally accepted checklist prior to pain procedure is yet to be found. Here, I suggest an initial structure of a checklist specifically designed for the pain procedures. Modification with time is well expected.

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Original Article

Jayashree Venkatesan, J Balavenkatsubramanian

Acceptance of Transverse Sweep vs Backtracking Method for Ultrasound-guided Interscalene Block in Awake Patients

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:3] [Pages No:75 - 77]

Keywords: Backtracking, Interscalene block, Pain, Transverse sweep

   DOI: 10.5005/jp-journals-10046-0151  |  Open Access |  How to cite  | 

Abstract

Background: Ultrasound-guided interscalene block is widely practiced for upper extremity surgery. There are two methods of identifying the brachial plexus by interscalene method—transverse sweep and backtracking. These methods are also used to scan stellate ganglion and do interventional procedure for Complex Regional Pain Syndrome 1 (CRPS1) and Complex Regional Pain Syndrome 2 (CRPS2). The aim of this study was to compare the two methods in an awake patient, the level of patient’s comfort, acceptance, and presence of any symptoms like coughing, choking, vomiting, dyspnea, and pain. Materials and methods: In total, 100 patients undergoing upper extremity surgery requiring interscalene block were scanned with SonoSite Edge, high-frequency linear probe (6–13 Hz) by both the transverse and backtracking methods. All patients were subjected to both the methods of scanning, and the level of patient’s comfort was compared. We categorized the comfort level into three levels—comfortable, mild discomfort, and significant discomfort. We measured pain with the help of unidirectional verbal rating scale as no pain, mild, moderate, and severe. Also, we recorded the associated symptoms including choking sensation, nausea, vomiting, cough, and dyspnea. Results: Even though the number of events was smaller in number in the transverse sweep method, the backtracking method scored over the transverse method. The transverse method caused some percentage of nausea (4%), choking (12%), dyspnea (6%), and mild pain (12%) and was statistically worse than the backtracking method. Although the comfort levels were not comparable statistically, due to lack of sufficient subgroups, transverse sweep patients had discomfort ranging from mild to significant compared with the comfortable feeling reported by all, when the backtracking method was used. Conclusion: The acceptance of the backtracking method was better than the transverse sweep method while scanning for ultrasound-guided block in awake patients.

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REVIEW ARTICLE

Venu Narayanapanicker, Gautam Das

Cryoneurolysis: Is it the Future of Neurolysis…?

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:3] [Pages No:78 - 80]

Keywords: Cryoablation, Cryoneurolysis, Deafferentiation, Nerve injury, Regeneration

   DOI: 10.5005/jp-journals-10046-0153  |  Open Access |  How to cite  | 

Abstract

The various methods available for neurolysis include surgical ablation, chemical ablation, thermal ablation, cryoablation, and mechanical compression. Cryoneurolysis is the direct application of low temperature to ablate nerves to provide pain relief. The cryoprobe consists of a hollow tube with a smaller inner tube. Pressurized gas travels down the inner tube and is released into the larger outer tube through a very fine aperture that allows the gas to rapidly expand into the distal tip. This extracts heat from the tip of the probe resulting in extremely low temperatures at the tip itself forming an ice ball. The severities of cryolesion are dependent on the cryotemperatures. The cryo technology has been used in many other specialities. The sophisticated architecture of the probe was the real limiting factor in manufacturing extremely narrow gauge probes till very recently. The absence of nerve injury beyond second degree makes cryoneurolysis extremely safe weapon. In case of any inadvertent motor damage during cryoneurolysis the fibres recovers completely within a short span where as the pain fibres are ablated for a longer period. Apart from the above, still more facts like minimal procedural pain, immediate onset of action and versatile utility in chronic pain anywhere in the body make it a perfect choice for the future of neurolysis.

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CASE REPORT

MV Anagha, Rangalakshmi , Gautam Das

Management of a Case of Inguinodynia Following Hernia Repair

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:2] [Pages No:81 - 82]

Keywords: Ilioinguinal nerve and iliohypogastric nerve blocks, Inguinodynia, Ultrasonography

   DOI: 10.5005/jp-journals-10046-0146  |  Open Access |  How to cite  | 

Abstract

Chronic groin pain (inguinodynia) following hernia repair is a significant, though less reported, problem. The reason for it is due to damage to inguinal nerves, symptoms of which vary from dull ache to sharp shooting pain along the distribution of inguinal nerves. Our case report is about a 62-year-old male presenting with pain along the line of incision in the inguinal crease bilaterally managed by ilioinguinal and iliohypogastric nerve blocks under ultrasonography (USG) guidance with triamcinolone, 0.5% lignocaine, and normal saline. Post procedure, the patient had significant pain relief.

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CASE REPORT

Laxmi Pathak, Khaja J Khan, Gautam Das

Cryoneurolysis for Post-hysterectomy Scar Neuralgia: An Innovative Management Approach

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:2] [Pages No:83 - 84]

Keywords: Cryoablation, Cryoneurolysis, Post scar neuralgia

   DOI: 10.5005/jp-journals-10046-0145  |  Open Access |  How to cite  | 

Abstract

When a small skin nerve is injured or squeezed by the scar tissue, it may cause pain in the scar tissue. Patient with pain after abdominal hysterectomy, a common gynecological operation, can be an ideal model for postoperative pain studies. Cryoneurolysis of nerves is the technique used to treat neuropathic pain, but the report on its use to treat postoperative abdominal scar neuralgia is not available. So we present a case report of a 39-year-old female patient who complained of burning and excruciating pain over her post hysterectomy scar since the last 4 years which did not relieve even with conservative medical management. We gave a diagnostic block along the scar tissue and found positive result. Then we did cryoneurolysis of the scar tissue under ultrasonography guidance, after which patient had significant pain relief.

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CASE REPORT

Archana Y Nankar, Khaja J Khan, Gautam Das

Dry Needling: A Beneficial Alternative for Managing Trigeminal Neuralgia in a Young Patient: A Case Report

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:2] [Pages No:85 - 86]

Keywords: Dry needling, Trigeminal neuralgia, Young patients

   DOI: 10.5005/jp-journals-10046-0147  |  Open Access |  How to cite  | 

Abstract

Trigeminal neuralgia (TN) typically affects the elderly and is uncommon in younger people. Managing a young patient resistant to pharmacological treatment could be challenging. Radiofrequency (RF) ablation of gasserian ganglion due to its side effects like deafferentation pain is a less desirable option. Dry needling reduces peripheral and central sensitization by its action on the descending pain inhibitory system and segmental antinociception. It has been successfully used to treat a variety of neuromusculoskeletal pain syndromes and could be effective in such patients. Here we present a case of a 22-year-old young man with TN of the right side of his face for 4 years, involving all the three divisions of the trigeminal nerve. He was being treated for the same with carbamazepine 200 mg thrice daily since 2 years. He suffered from paroxysms of electric shock like pain either occurring spontaneously or triggered by nonnoxious stimuli to specific areas of his face called as trigger zones. We treated him with dry needling, done in these trigger zones, which gave him more than 50% pain relief after two sessions. Hence, we conclude that dry needling could be a beneficial alternative for managing young patients with refractory TN.

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CASE REPORT

Venu Narayanapanicker, Bhupider Pal Singh, Gautam Das

Lumbar Sympathectomy in an Ankylosing Spondylitis Patient with Vasculitis: A Case Report

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:3] [Pages No:87 - 89]

Keywords: Ankylosing spondylitis, Leg pain, Leg ulcer, Lumbar sympathetic block, Vasculitis

   DOI: 10.5005/jp-journals-10046-0148  |  Open Access |  How to cite  | 

Abstract

In ankylosing spondylitis (AS), the axial skeleton, peripheral joints, and extra-articular structures are also frequently involved. Cutaneous lesions and vasculitis is extremely rare. Lumbar sympathectomy has a definite role in patients with painful cutaneous vasculitis and ischemic leg ulcer, especially those refractory to medical management. Despite the relatively small percentage of patients suffering from chronic leg ulcer, it has a significant impact on the patient’s quality of life. A 44-year-old male AS patient with low backache (LBA) of 15 years and bilateral leg pain came to us. But in the past 2 years, severity of pain worsened resulting in infection and ulcer of dorsum of both feet. Examination confirmed multiple ulcers along with sensory loss on the dorsum of foot bilaterally. Not only he was refractory to conventional medical management, but he also had developed various side effects. Our results of diagnostic left lumbar sympathetic block (LSB) turned out to be positive. Next day, radiofrequency ablation (RFA) of lumbar sympathetic chain bilaterally at L2, L3, and L5 was done, and the patient was discharged pain free. At the 3-month review, the leg ulcers had healed, and the patient was pain free. So here, we discuss about the possible mechanisms and the role of LSB in vasculitic leg ulcers.

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CASE REPORT

MV Anagha, Rangalakshmi , Gautam Das

Stellate Ganglion Block for Treatment of Patient with Raynaud’s Syndrome

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:2] [Pages No:90 - 91]

Keywords: Raynaud’s syndrome, Stellate ganglion block, Ultrasonography

   DOI: 10.5005/jp-journals-10046-0149  |  Open Access |  How to cite  | 

Abstract

Raynaud’s syndrome is characterized by abnormal vascular constriction of digits and extremities from a widespread of interaction of sympathetic nervous system, vascular endothelium, and endocrine system. Our case report is about a 65-year-old female, farmer by occupation presenting with pain and discoloration of distal phalanx of index, middle, and ring fingers of right hand treated with stellate ganglion block under ultrasonography (USG) guidance with a combination of triamcinolone, 0.5% lignocaine, and normal saline. Post procedure, Horner’s syndrome noted to confirm the block, and 24 hours later, the patient had significant pain relief with slight improvement of the discoloration.

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CASE REPORT

Khaja J Khan, Gautam Das

Cryoneurolysis of Genitofemoral Neuralgia: A Case Report

[Year:2019] [Month:September-December] [Volume:5] [Number:3] [Pages:3] [Pages No:92 - 94]

Keywords: Cryoablation, Cryoneurolysis, Genitofemoral neuralgia, Ultrasound

   DOI: 10.5005/jp-journals-10046-0154  |  Open Access |  How to cite  | 

Abstract

Cryoneurolysis by means of using low temperatures reversibly ablates the nerves and provides good analgesia. The duration varies from few months to 1 year. Genitofemoral neuralgia is mainly an iatrogenic neuropathy. With growing knowledge and technique, ultrasound-guided cryoneurolysis of the genitofemoral nerve is a safe and effective measure to treat genitofemoral neuralgia. We are reporting a case of successful cryoablation of the genitofemoral nerve using ultrasound in a patient with chronic inguinal pain after vulvectomy for vulvar cancer extending to the anorectal sphincter. After surgery, the patient was suffering from burning pain around the upper and medial side of the thigh. This was not getting relieved by oral analgesics. The verbal response scale (VRS) was still 8 on analgesics. So, we decided to go for cryoneurolysis of the genitofemoral nerve.

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