Persistent Idiopathic Facial Pain Originating from Cervical Abnormalities.

BACKGROUND: Persistent idiopathic facial pain is characterized by persistent facial or oral pain in the absence of a neurologic deficit. This underexplored pain may be conducted by various nerves, including cranial nerves and upper cervical spinal roots, and its etiology is unclear. CASE DESCRIPTION: A patient presented with persistent idiopathic facial pain associated with occipital muscle stiffness after an improper neck massage. The patient achieved almost complete pain relief by coblation of right upper cervical nerves (C1 and C2 spinal roots) followed by continuous cervical epidural analgesia for a period of 3 weeks. The analgesic effect was stable during the 3-month follow-up period. CONCLUSIONS: Persistent idiopathic facial pain may be cervicogenic, and treatments focusing on cervical spinal roots may provide satisfactory pain control in patients with cervical abnormalities.

Computed Tomography-Guided Percutaneously Controlled Ablation of the Thoracic Paravertebral Nerve Due to Thoracic Neuropathic Pain.

BACKGROUND: Patients with thoracic neuropathic pain often do not respond to medication and physical therapy. Coblation technology has been demonstrated to have potential for pain management. METHODS: Fifteen patients underwent computed tomography-guided percutaneous coblation to ablate the thoracic paravertebral nerve for their medication-resistant thoracic neuropathic pain. The pain intensity was assessed by visual analog scale (VAS) 1 day before surgery and 1 week and 1, 3, and 6 months after surgery, and the difference between preoperative and postoperative VAS values was determined to evaluate the pain relief effectiveness. Patients who achieved > 50% pain relief were defined as responders, and the ratio in all patients was calculated. The number of patients who reported mild pain (VAS ≤ 3) was recorded, and the ratio in all responders was calculated. In addition, adverse effects were also recorded to investigate the security of procedure. RESULTS: Twelve (80%) responders achieved > 50% pain relief. The VAS score of responders significantly decreased from 7.42 ± 1.38 before surgery to 2.17 ± 1.11 (P = 0.000), 1.92 ± 1.16 (P = 0.000), 1.75 ± 0.97 (P = 0.000), and 1.58 ± 1.08 (P = 0.000) at 1 week, 1, 3, and 6 months after surgery, respectively. The number of responders with mild pain was 10 (83.3%), 11 (91.7%), 12 (100%), and 12 (100%) at 1 week, 1, 3, and 6 months after surgery, respectively. All responders and 1 nonresponder reported slight numbness after the surgery. CONCLUSION: Percutaneous thoracic paravertebral nerve coblation guided by computed tomography is a potential method for the treatment of thoracic neuropathic pain.