RESUMO
Objective: Painful post-traumatic trigeminal neuropathy (PTTN) is a clinical pain syndrome that occurs due to injuries to the peripheral branches of the trigeminal nerve and is characterized by a deep burning pain and accompanied by positive and negative neurological signs. In patients with recalcitrant PTTN, the sympathetic nervous system is a potential therapeutic target. The aim of this study was to investigate the therapeutic response of PTTN patients to pulsed radiofrequency treatment (PRF) of the superior cervical sympathetic ganglion (SCG).Methods: Thirty-five patients with PTTN who had a history of severe disabling facial neuropathic pain underwent PRF of the SCG under a new lateral fluoroscopic approach.Results: The patients' pain intensity post-PRF was 3.94 (± 3.11), compared with 8.82 (± 1.27) pre-PRF (p < 0.001).Conclusion: PRF of the SCG could be an effective method to treat chronic PTTN.
Assuntos
Tratamento por Radiofrequência Pulsada , Traumatismos do Nervo Trigêmeo , Neuralgia do Trigêmeo , Humanos , Dor , Tratamento por Radiofrequência Pulsada/métodos , Gânglio Cervical Superior , Resultado do Tratamento , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/terapiaAssuntos
Anestésicos Locais/uso terapêutico , Bloqueio Nervoso Autônomo/métodos , Toxinas Botulínicas Tipo A/efeitos adversos , Botulismo/induzido quimicamente , Síndromes da Dor Regional Complexa/tratamento farmacológico , Disartria/induzido quimicamente , Fármacos Neuromusculares/efeitos adversos , Adulto , Fraturas do Tornozelo , Botulismo/fisiopatologia , Feminino , Humanos , Lidocaína/uso terapêutico , Vértebras Lombares , Recuperação de Função FisiológicaAssuntos
Dor Crônica/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Fraturas das Costelas/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Dor Crônica/etiologia , Dor Crônica/cirurgia , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas das Costelas/complicações , Fraturas das Costelas/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgiaRESUMO
OBJECTIVE: The objective is to present a hypothesis to explain the sensory, autonomic, and motor disturbances associated with complex regional pain syndrome (CRPS) syndrome. METHODS: The author reviewed the available and relevant literature, which was supplemented with research on experimental animal models, with a focus on how they may translate into humans, particularly in areas about pathophysiologic mechanisms of CRPS. RESULTS: We propose that different CRPS subtypes may result from facilitative or inhibitory influences exerted by the spinal-coeruleo-spinal pathway in three sites at the spinal cord: the dorsal horn (DH), intermediolateral cell column (IML) and ventral horn (VH). A facilitatory influence over DH may have a pronociceptive effect that explains exacerbated pain, sensory disturbances, and spreading sensitization and neuroinflammation. Conversely, a facilitatory influence over preganglionic neurons located in IML cell column may increase sympathetic outflow with peripheral vasoconstriction, which leads to cold skin, ipsilateral limb ischaemia, and sympathetically maintained pain (SMP). For patients presenting with these symptoms, a descending inhibitory influence would be predicted to result in decreased sympathetic outflow and warm skin, as well as impairment of peripheral vasoconstrictor reflexes. Finally, a descending inhibitory influence over VH could explain muscle weakness and decreased active range of motion, while also facilitating motor reflexes, tremor and dystonia. CONCLUSIONS: The proposed model provides a mechanistically based diagnostic scheme for classifying and explaining the sensory, autonomic and motor disturbances associated with CRPS syndrome.
