Pain Treatment

The Peripheral Neuropathy Solution

Peripheral Neuropathy Program By Dr. Randall Labrum

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PERIPHERAL TECHNIQUES

Generally used for more benign conditions and before resorting to central techniques.

NERVE BLOCKS: Injections of agents into peripheral nerves or roots abolishes pain in the appropriate dermatome; motor and sympathetic function are also lost. Local anaesthetics produce a temporary effect; neurolytic agents, e.g. phenol, alcohol, give permanent results.

— Intraspinal phenol or hypertonic saline for chronic pain usually used in patients with terminal v malignancy. \

— Epidural local anaesthetic produces temporary analgesia. Narcotic infusion appears useful for controlling postoperative pain and intractable pain in patients with terminal malignancy. v ^

- Sympathetic Ganglion or Trunk - anaesthetics or neurolytic agent often helps causalgic pain.---__

- Paravertebral or Peripheral Nerve

- local anaesthetics may benefit temporary pain states, e.g. fractured rib, but neurolytic agents often _______

cause a painful neuritis

ACUPUNCTURE:

Insertion and rotation of needles in specific cutaneous points appears to produce some analgesia in acute pain. Long-term results in chronic pain are disappointing. Although endorphin release occurs, the role of the placebo effect remains unclear.

- DORSAL RHIZOTOMY:

Division of the dorsal roots via a laminectomy has a high failure rate and provides only short lasting benefit. Now seldom performed.

- DORSAL RHIZOTOMY:

Division of the dorsal roots via a laminectomy has a high failure rate and provides only short lasting benefit. Now seldom performed.

FACET JOINT INJECTION:

Depomedrone combined with marcaine, injected into the facet joints, helps some patients with backpain from osteoarthritic degeneration and can be repeated as required. Alternatively a percutaneous radiofrequency heat lesion applied to the posterior ramus of the spinal nerves exiting from the intervertebral foramen, denervates the facet joints. This technique relieves facet joint pains in the majority of patients, but as the nerve regenerates, pain returns unless preventative measures are adopted.

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS):

Prolonged electrical stimulation over the affected site often alleviates pain of peripheral origin. This technique acts either by stimulating large diameter fibres, closing the 'gate' at the dorsal root entry zone or via higher centres.

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