PainJournal.net
Clinical Journal of Pain for
Healthcare Professionals and Patients
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PainJournal.net Clinical Journal of Pain for Healthcare Professionals and Patients
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THE ROLE OF NERVE BLOCKS AND INFRARED THERMAL IMAGING IN THE DIAGNOSIS AND TREATMENT OF NEUROPATHIC PAIN
H. Hooshmand, M.D., Masood Hashmi, M.D., and Eric M. Phillips Neurological Associates Pain Management Center 1255 37th Street, Suite B Vero Beach, Florida 32960
The standard nerve blocks for neuropathic pain are sympathetic ganglion blocks. However, these blocks are not consistently successful. Bonica has stated that even in the hands of experts, the blocks are technically successful in no more than 75% of patients[1]. In addition, such blocks usually last for a short period of time (from minutes, hours, to days). As such, these blocks are more diagnostic than therapeutic in nature. This is an ongoing comparative study of the diagnostic and therapeutic values of nerve blocks. Four groups of 100 patients were studied for the efficacy of sympathetic versus epidural, regional (BIER), and brachial plexus blocks. The temperature measurement of the region was done with Bales Scientific Infrared Imaging Thermography. 1. Sympathetic nerve blocks: These nerve blocks were most effective in the first few months after the injury. In addition, repetitive blocks eventually destroy the ganglion, causing “Virtual Sympathectomy”[2-4]. In the first six months, the success of sympathetic nerve blocks was rated at 72%. From six months to two years, the success rate (warming up of the extremity and pain relief) was reduced to 51%. 2. Cervical and lumbar epidural blocks containing 15-20mg Depo-Medrol® showed a success rate of 89%. The thermal imaging showed similar degree of warming of the extremities (3-8 ºC) in groups one and two. The inclusion of Depo-Medrol® in the epidural blocks provides pain relief as well as neutralizing the inflammatory damages due to sympathetic nervous system dysfunction. 3. The regional BIER block showed far lower success rate (32%) probably due to trauma to the thermosensory nerves in distal portion of extremity causing further flare-up of the regional pain (i.e., CRPS). The difference of temperature (D-T) between the two sides was significant but rapidly reversed back to the original pathology in matter of 36 to 48 hours. 4. The brachial plexus block axillary approach showed a high success rate in regards to analgesia and hyperthermia (63%). CONCLUSION Diagnostic blocks should not be mistaken for therapeutic blocks. Regional blocks have a tendency to aggravate the pain and neuroinflammation in the involved extremity.
References 1.Bonica JJ: The management of pain. Lea & Feibger Philadelphia 1990; Vol. 1: p 229 2. Hooshmand H: Is thermal imaging of any use in pain management? Pain Digest. 1998; 8:166-70. 3.Hooshmand H, Hashmi M: Complex regional pain syndrome (CRPS, RSDS) diagnosis and therapy. A review of 824 patients. Pain Digest. 1999; 9: 1-24. 4. Hooshmand H, Hashmi M, Phillips E.M. : Infrared thermal imaging as a tool in pain management- An 11 year study, Part II: Clinical applications. Thermology International. 2001; 3: 117-129.
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