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In Nerve Blocks: Medication Injected to Control Pain, Part I,
we reviewed spinal injections. This time we will discuss
some of the other common nerve blocks. Remember, blocks
are not the best treatment for all pain problems. Even
when they are appropriate, they are usually more effective
as a part of a comprehensive treatment strategy. Such
a strategy may involve medications, physical therapy,
occupational therapy, stress management, relaxation training,
acupuncture, or other treatments.
Peripheral Nerve Blocks
Let's begin by taking a
look at peripheral nerves, the nerves outside of the brain
and spinal cord. These nerves transmit sensation and motor
(movement) control. They can be damaged by trauma, surgery,
scar tissue, or illness. Blocks of peripheral nerves can
help provide relief. Here are three examples of common
peripheral nerve blocks:
1. The occipital nerves
travel from the cervical spine in the neck to the back
of the head and scalp. These nerves can be damaged by
arthritic changes in the cervical spine, by muscle spasm,
or by neck injuries. The result can be headaches which
typically start in the back of the neck and spread towards
the forehead. Occipital nerve blocks with steroids can
often help.
2. Chest injuries or surgery
can injure the intercostal nerves, and trigger chronic
chest wall pain. A valuable part of the treatment may
be to block or even freeze these nerves.
3. The ilioinguinal nerve
wraps around the rim of the pelvis and goes to the inguinal
(groin) and pubic areas. The nerve can be damaged by surgery
or by subsequent scar tissue following hernia repairs
and cesarean sections. Here too, nerve blocks may enhance
the treatment.
Sympathetic Nerve Blocks
Chronic pain conditions
often involve malfunctions of the sympathetic nerves.
These nerves regulate blood flow, sweating, and glandular
function. Blocks of these sympathetic nerves can provide
important diagnostic information, and can also lead to
a reduction of the pain. Here are four examples of common
sympathetic nerve blocks:
1. The sympathetic nerves
of the stellate ganglion lie just in front of the spine
in the lower neck. Blocking these nerves can help with
pain conditions involving the face, arms and hands.
2. Similarly, the lumbar
sympathetic nerves in front of the spine of the lower
back can be blocked to help with pain conditions of the
legs and feet.
3. Pelvic pain often involves
the sympathetic nerves in front of the sacrum. These nerves
can be blocked with injections just above or below the
sacrum.
4. The celiac plexus (the
solar plexus) is a bundle of sympathetic and sensory nerves
which transmits much of the sensation from the abdominal
organs. Celiac plexus blocks can help control a variety
of chronic abdominal pains, especially cancer related
pains.
Many people are not aware
that trigger point injections are not truly nerve blocks,
rather they are muscle blocks. Muscles that are chronically
tense or in spasm become tender and painful. The pain
then triggers more spasm and a vicious cycle develops.
Physical therapy and exercise are the primary treatments,
but injections into the muscle can help to break the cycle.
Recent Advances in Injection
Technique
Until a few years ago, most
blocks were placed "blindly," according to the doctor's
"feel" of the patient's anatomy. Now, much more accurate
needle placement is achieved by using fluorscopic (x-ray)
guidance. In difficult cases, where the anatomy might
be distorted by tumors, then CT guidance is used. The
other new development is the use of curved needle techniques
for deeper injections. By using curved needles and fluoroscopic
guidance, the pain specialist can gently twist and turn
the needle directly to the target. This avoids the use
of multiple attempts to get the needle properly positioned.
The result is better needle placement with less discomfort.
Copyright
© 2000, Steven Richeimer, MD.
You may reach The Richeimer Pain Institute at www.helpforpain.com
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