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DSA guidance: DSA-guided puncture was used in each group to select a safe puncture route to avoid damage to blood vessels or lung tissue and clarify where the puncture needle would reach the target site (a, b). DSA-guided orthopantomogram of the puncture (c, d).
Source publication
Objective:
Under the guidance of a digital subtraction angiography (DSA) machine, via fluoroscopic imaging techniques, patients diagnosed with herpes zoster neuralgia at the subacute stage, where self-reported pain lasts between 30 and 90 days, were treated with nerve pulsed radiofrequency surgery combined with intravenous lidocaine infusion or sa...
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Background
Axillary vein puncture is a popular puncture site for pacemaker implantation. However, due to the lacking of body surface markers, the current puncture method is too complicated and affect the popularization and application of axillary vein puncture. Here, we performed a new body surface landmark to make the blind axillary vein puncture...
Citations
... in the literature review, a series of studies focused on PRF and/or PNs neuromodulation therapy for pain management of hZO were identified (table 2) [13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Despite hZO, other indication of neuromodulation usage for facial pain management includes idiopathic, postsurgical, traumatic, post-stroke, multiple sclerosis, radioactive, classic trigeminal neuralgia and other unclassified types of aetiology [16,[20][21][22][23]. Multiple phases of herpetic disease (acute, subacute and PhN) can be considered to undertake neuromodulation treatment, ranging from 2 weeks to 30 years. the majority of previous data were obtained from observational cohort studies or case series, and about 23% (5 out of 22) were randomized controlled trials [29,30,32,35]. to treat hZO-related neuralgia, supraorbital and infraorbital branches are commonly targeted for stimulator implantation. ...
... in the literature review, a series of studies focused on PRF and/or PNs neuromodulation therapy for pain management of hZO were identified (table 2) [13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Despite hZO, other indication of neuromodulation usage for facial pain management includes idiopathic, postsurgical, traumatic, post-stroke, multiple sclerosis, radioactive, classic trigeminal neuralgia and other unclassified types of aetiology [16,[20][21][22][23]. Multiple phases of herpetic disease (acute, subacute and PhN) can be considered to undertake neuromodulation treatment, ranging from 2 weeks to 30 years. the majority of previous data were obtained from observational cohort studies or case series, and about 23% (5 out of 22) were randomized controlled trials [29,30,32,35]. to treat hZO-related neuralgia, supraorbital and infraorbital branches are commonly targeted for stimulator implantation. Unlike classical trigeminal neuralgia, less herpetic cases present with mandibular lesions, and the implantable neuromodulation can also be applied directly to this region [18,19,22] or in the trigeminal ganglion [23]. ...
Background
Effective pain control of herpes zoster ophthalmicus (HZO) is not only essential to attenuate the clinical symptoms but to reduce the risk of postherpetic neuralgia development. Recently, neuromodulation therapy has been one promising option for neuropathic pain and increasingly applied in management of zoster-related pain. One key factor of neuromodulation treatment is the therapeutic site for the impaired nerves. In this study we aim to investigate one novel dual-neuromodulation strategy, targeting the level of the peripheral branch and trigeminal ganglion, in the pain management of HZO.
Methods
Dual neuromodulation strategy combining short-term peripheral nerve stimulation (PNS) with pulsed radiofrequency (PRF) of trigeminal ganglion was compared with single PNS treatment for HZO-related pain. Clinical recordings of patients were retrospectively reviewed. The primary outcome was the pain severity, assessed by the visual analogue scale (VAS) before and after neuromodulation therapy.
Results
PNS achieved significant relief of pain with or without PRF treatment before discharge, which provided enduring therapeutic effect up to 12-month follow-up. The mean reduction of VAS was 6.7 ± 1.4 in dual modulation therapy (n = 13) at last follow-up and 5.4 ± 1.5 in PNS subgroup (n = 20), respectively. Moreover, dual modulation strategy provided better control of pain compared with PNS therapy alone at each time point.
Conclusion
It is feasible and effective to combine the PNS and PRF in pain management of HZO. This novel dual modulation strategy of trigeminal pathway may provide additional therapeutic effects of pain symptoms in HZO population.
... It has also been observed that the usage of opioids and its negative side effects may be decreased by using lidocaine. [21][22][23] In this work, we considered the potential mechanism by which lidocaine infusion reduces neuropathic pain discomfort. Lidocaine's short-term impact, sodium channel blockade, which closes the sodium channel of the afferent fibers at the pain site and hinders the transmission of pain signals, may account for the pain reduction seen upon completion of the infusion. ...
Background: Neuropathic pain is a type of chronic pain that is related to nerve damage and is defined by the International Association of Study of Pain (IASP) as “pain caused by a disease or lesion of the somatosensory nervous system”. It remains a challenging clinical problem as pain often can be quite severe and debilitating. The rationale of this study is to find out the efficacy of intravenous lidocaine infusion for neuropathic pain management in our population as there has been no study conducted in Pakistan for this purpose. As our country has a rather low-income population and cheaper options for treatment need to be explored. Objective: To determine the efficacy of lidocaine infusions of 3 mg/kg in managing the chronic neuropathic pain given at 0,1, 2 and 3 weeks in comparison to the placebo infusion. Study Design: Case control study. Settings: The study was conducted in the Sheikh Zayad Hospital Lahore Pakistan. Duration: July 2022 to December 2022. Methods: 100 outdoor patients fulfilling the inclusion and exclusion criteria were enrolled after taking informed written consent and were randomly allocated to Lidocaine group (A) 3 mg/kg, diluted in 50 ml normal saline and placebo group (B) 50 ml intravenously over 30 minutes. The Lidocaine group was injected with lidocaine, intravenously over 30 minutes once a week for 4 weeks. Patients with established diagnosis of neuropathic pain, adults of both genders, age above 18 years were enrolled in this study. Their pain severity was recorded using Numerical rating scale (NRS). The data of both groups was recorded in predesigned proforma and efficacy was also noted as labelled as Yes/No for two points; 1: Decrease in pain score by at least 2 out of 10 and 2: Decrease in oral analgesics intake. Results: There were 50 patients in group A and B with the mean age of 53.82 years and 54.4 years respectively. Patients in group A who received an intravenous infusion of lidocaine reported less severe pain and fewer instances of breakthrough pain. No statistically significant difference (P>0.05) was discovered between NRS ratings before and after infusions in the control group despite the fact that several patients reported lower pain intensity after the infusion. The quantity of opioid used was determined for the Lidocaine and Placebo groups. Opioid in the placebo group was 0.472–0.572 g per patient, but in the Lido group it was only 0.1–0.2 g per patient which is significantly different from placebo group (p=0.0021). Conclusion: Lidocaine intravenous infusion (3 mg/kg daily for 4 weeks) improved short-term results of therapy, decreased the need for analgesic medication, and shortened pain score without causing major adverse effects.
... Fei et al.22 confirmed that PRF combined with paravertebral injection of recombinant human interferon-α2b was an effective treatment for acute stage herpes zoster neuralgia. Zhang et al.23 reported that PRF combined with intravenous lidocaine infusion can effectively relieve pain, reduce the number of analgesic drugs used, and improve sleep and quality of life. In fact, the DRG is a key structure in PRF treatment. ...
Background
Herpes zoster (HZ)‐related pain, characterized by chronic and persistent pain with a dermatomal distribution, is a relatively common complication of HZ. Pulsed radiofrequency (PRF) can effectively relieve HZ‐related pain. There is no study on the effect of the needle tip position in patients with HZ for PRF treatment. This prospective study was conducted to compare two distinct needle tip positions in PRF for HZ‐related pain.
Methods
Seventy‐one patients suffering from HZ‐related pain were enrolled in this study. According to the dorsal root ganglion (DRG) position and needle tip position, patients were randomly allocated to the IP group (group inside of the pedicle, n = 36) and OP group (group outside of the pedicle, n = 35). Quality of life and pain control were evaluated with the visual analog scale (VAS) and activities of daily living questionnaires (including 7 items: general activity, mood, walking ability, normal work, relations with other people, sleep, and enjoyment of life), which were administered before therapy and at intervals of 1, 7, 30, and 90 days after therapy.
Results
Before therapy, the mean pain score was found to be 6.03 ± 0.45 in the IP group and 6.00 ± 0.65 in the OP group (p = 0.555). No significant differences were found when the two groups were compared at 1 and 7 days after therapy (p > 0.05). But, the pain score was significantly lower in the IP group at 30 days (1.78 ± 1.31 vs. 2.77 ± 1.31, p = 0.006) and 90 days of follow‐up (1.29 ± 1.19 vs. 2.15 ± 1.74, p = 0.041). Significant differences between the two groups in terms of general activity (2.39 ± 0.87 vs. 2.86 ± 0.77, p = 0.035), mood (1.97 ± 1.65 vs. 2.86 ± 1.50, p = 0.021), relations with other people (1.94 ± 0.92 vs. 2.51 ± 1.22, p = 0.037), sleep (1.64 ± 1.44 vs. 2.97 ± 1.44, p < 0.001), and enjoyment of life (1.58 ± 1.11 vs. 2.43 ± 1.33, p = 0.004) were detected after the 30‐day follow‐up. In addition, scores for the activities of daily living were significantly lower in the IP group than that in the OP group at 90 days after therapy (p < 0.05).
Conclusion
The needle tip position had an influence on the PRF treatment in patients with HZ‐related pain. Positioning the needle tip in the area between the medial and lateral edges of adjacent pedicles offered good pain relief and improved quality of life in HZ patients.
