Surgical treatment of greater occipital neuralgia by neurolysis of the greater occipital nerve and sectioning of the inferior oblique muscle.

OBJECTIVES: To evaluate a new surgical treatment consisting of neurolysis of the great occipital nerve and section of the inferior oblique muscle. DESIGN.: A retrospective study of 10 patients operated for greater occipital neuralgia. SUMMARY AND BACKGROUND DATA: This technique is based on a previous anatomic cadaver study. The greater occipital nerve is stretched by the inferior oblique muscle of the head during flexion of the cervical spine. Sectioning this muscle relaxes the greater occipital nerve. With this procedure, the authors systematically associate release of the nerve down to the inferior edge of the inferior oblique muscle. METHODS: A retrospective study was conducted of 10 patients operated on from January 1998 to December 1999 for greater occipital neuralgia. All the patients had pain exacerbated by flexion of the cervical spine. The average age of the patients was 62 years. The mean follow-up of the series was 37 months. The results of the treatment were assessed according to three criteria: 1) degree of pain on a Visual Analogue Scale before surgery, at 3 months, and at last follow-up; 2) consumption of analgesics before surgery and at follow-up; and 3) the degree of patient satisfaction at follow-up. RESULTS: In three cases, anatomic anomalies were found. One patient had hypertrophy of the venous plexus around C2. In another, the nerve penetrated the inferior oblique muscle. The third had degenerative C1-C2 osteoarthritis requiring associated C1-C2 arthrodesis. The mean Visual Analogue Scale score was 80/100 before surgery and 20/100 at last follow-up. Consumption of analgesics decreased in all patients. Seven of the 10 patients were very satisfied or satisfied with the operation. CONCLUSION: This surgical technique gives good results on greater occipital neuralgia if patients are well chosen. Nerve release is justified by the frequency of associated anatomic abnormalities.

Is TENS purely a placebo effect? A controlled study on chronic low back pain.

Although high-frequency low-intensity transcutaneous electric nerve stimulation (TENS) has been extensively used to relieve low back pain, experimental studies of its effectiveness have yielded contradictory findings mainly due to methodological problems in pain evaluation and placebo control. In the present study, separate visual analog scales (VAS) were used to measure the sensory-discriminative and motivational-affective components of low back pain. Forty-two subjects were randomly assigned to 1 of 3 groups: TENS, placebo-TENS, and no treatment (control). In order to measure the short-term effect of TENS, VAS pain ratings were taken before and after each treatment session. Also, to measure long-term effects, patients rated their pain at home every 2 h throughout a 3-day period before and 1 week, 3 months and 6 months after the treatment sessions. In comparing the pain evaluations made immediately before and after each treatment session, TENS and placebo-TENS significantly reduced both the intensity and unpleasantness of chronic low back pain. TENS was significantly more efficient than placebo-TENS in reducing pain intensity but not pain unpleasantness. TENS also produced a significant additive effect over repetitive treatment sessions for pain intensity and relative pain unpleasantness. This additive effect was not found for placebo-TENS. When evaluated at home, pain intensity was significantly reduced more by TENS than placebo-TENS 1 week after the end of treatment, but not 3 months and 6 months later. At home evaluation of pain unpleasantness in the TENS group was never different from the placebo-TENS group.(ABSTRACT TRUNCATED AT 250 WORDS)