ABSTRACT
Trigeminal neuralgia (TN) is a chronic pain condition that affects the trigeminal nerve, the largest of the cranial nerves. It is characterized by severe, sudden, and recurrent facial pain, often triggered by light touch or a breeze. Treatment options for TN include medication, nerve blocks, and surgery, but radiofrequency ablation (RFA) has emerged as a promising alternative. RFA is a minimally invasive procedure that uses heat energy to destroy the small portion of the trigeminal nerve responsible for the pain. The procedure is performed under local anesthesia and can be done as an outpatient procedure. RFA has been shown to provide long-term pain relief for TN patients with a low complication rate. However, RFA is not suitable for all TN patients and may not be effective for those with multiple pain sites. Despite these limitations, RFA is a valuable option for TN patients who are not responding to other treatments. Furthermore, RFA is a good alternative for a patient unsuitable for surgery. Further research is needed to fully understand the long-term effectiveness of RFA and identify the best candidates for the procedure.
ABSTRACT
The chronic neuropathic pain of post-herpetic neuralgia (PHN) often persists for months or years after the acute herpes zoster (shingles) episode, may be severe and intractable, and can severely impact the overall quality of life. Antivirals, analgesics, and nerve blocks can effectively shorten the course of shingles and may help to prevent PHN. Although vaccination effectively prevents shingles and PHN, current therapies may be ineffective, and pain management can be challenging when PHN occurs. A 78-year-old female with severe PHN pain in the right thoracolumbar spine, right flank, and right lower abdomen showed poor responses to treatment with amitriptyline, gabapentin, and oxycodone/acetaminophen. However, a series of three thoracic transforaminal epidural steroid injections (TFESIs) effectively treated the PHN and achieved near-complete pain resolution. TFESI can be considered an early and first-choice treatment for PHN, but several courses may be required to achieve adequate and prolonged symptom control.
ABSTRACT
Chronic axial low back pain (LBP) is one of the most common ailments in the United States, with a significant impact on quality of life and function. Multimodal therapy is often utilized for pain relief, including opioid pain medication. Current indications for spinal cord stimulation include chronic neuropathic conditions, such as failed back surgery syndrome, radiculopathies, complex regional pain syndrome types I and II, postherpetic neuralgia, and peripheral diabetic neuropathies. While current lead placements perform remarkably when used for their appropriate indications, there is no specific indication for spinal cord stimulation in the treatment of axial LBP. However, spinal cord stimulation lead placement at the T6 mid-vertebral body can be considered in patients with significant or predominant complaints of axial LBP. Achievement of pain relief via spinal cord stimulation can reduce the administration of both opioid and non-opioid pain medications.
