Treatment of post-traumatic pain, and autonomic and muscular dysfunction by ganglion impar block and medial branch block of the facet joints: A case report

Scandinavian Journal of Pain - Tập 3 - Trang 238-240 - 2012
Johan Hambræus1, Hans Westergren2
1Smärtkliniken i Umeå, Kungsgatan 42, 903 25 Umeå, Sweden
2Section for Specialized Pain Rehabilitation, Department of Rehabilitation Medicine, Skåne University Hospital and Department of Health Sciences, Lund University, Sweden

Tóm tắt

Abstract Introduction Patients exposed to whiplash trauma are at risk of developing pain and dysfunction of the neck and shoulder. Although rarely discussed in the literature, some patients also develop autonomic dysfunction. Case presentation A previously healthy 41-year-old woman was involved in a “head-on” car crash. During the following 3 years she developed severe and complex post-traumatic pain syndrome, which consisted of neck pain, lumbar pain, sensory-motor dysfunction, and myoclonic muscular contractions. Despite pharmacotherapy, physiotherapy, and rehabilitation, her condition worsened, resulting in severe disability. Fourteen years after the car crash, an interventional pain therapy program was started, which consisted of sympathetic ganglion impar block and medial branch blocks of facet joints at different levels. These treatment strategies ultimately normalized her sensory-motor dysfunction, reduced her autonomic dysfunction, and stopped the myoclonic muscular contractions. Conclusion This case highlights a possible interaction between the pain-generating facet joints, the somatosensory nervous system, and the autonomic/sympathetic nervous systems. The case also highlights the importance of identifying autonomic dysfunction in patients with persisting pain syndromes. Implications This complex case shows that many clinical phenomena cannot be explained using our present knowledge of pain mechanisms. We hope that readers who have observed similar cases can learn from our case, and are encouraged to publish their observations.

Tài liệu tham khảo

Jull GA, Sterling M, Curatolo M, Carroll L, Hodges P. Toward lessening the rate of transition of acute whiplash to a chronic disorder. Spine 2011;36: S173–4. Passatore M, Roatta S. Influence of sympathetic nervous system on sensorimotor function: whiplash associated disorders (WAD) as a model. Eur J Appl Physiol 2006;98:423–49. Cepeda MS, Carr DB, Lau J. Local anesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev 2005: CD004598. Lipov EG, Joshi JR, Sanders S, Slavin KV. Aunifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Med Hypotheses 2009;72:657–61. Nelson DV, Stacey BR. Interventional therapies in the management of complex regional pain syndrome. Clin J Pain 2006;22:438–42. Pfister M, Fischer L. The Treatment of the Complex Regional Pain Syndrome (CRPS 1 and CRPS 2) of the upper limb with repeated local anaesthesia to the stellate ganglion. Praxis (Bern 1994) 2009;98:247–57. Yucel I, Demiraran Y, Ozturan K, Degirmenci E. Complex regional pain syndrome type I: efficacy of stellate ganglion blockade. J Orthop Trauma 2009;10:179–83. Burstrom K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 2001:621–35. van Hilten JJ. Movement disorders in complex regional pain syndrome. Pain Med 2010;11:1274–7. Quevedo JP, Purgavie K, Platt H, Strax TE. Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option. Arch Phys Med Rehabil 2005;86:335–7. Bogduk N, On cervical zygapophysial joint pain after whiplash. Spine 2011;36:S194–9. Winkelstein BA. How can animal models inform on the transition to chronic symptoms in whiplash? Spine 2011;36:S218–25. Ahmed M, Bjurholm A, Kreicbergs A, Schultzberg M. Sensory and autonomic innervation of the facet joint in the rat lumbar spine. Spine 1993;18: 2121–6. Ohtori S, Takahashi K, Chiba T, Yamagata M, Sameda H, Moriya H. Sensory innervation of the cervical facet joints in rats. Spine 2001;26:147–50. Cavanaugh JM, Lu Y, Chen C, Kallakuri S. Pain generation in lumbar and cervical facet joints. J Bone Joint Surg Am 2006;88(Suppl 2):63–7. Wasner G. Vasomotor disturbances in complex regional pain syndrome – a review. Pain Med 2010;11:1267–73. Merskey H. Somatization: or another God that failed. Pain 2009;145:4–5.
Thông tin
Thông tin xuất bản

Scandinavian Journal of Pain

Tập 3

238-240

Thông tin tác giả