scholarly journals Peripheral Nerve Stimulation of the Brachial Plexus for Chronic Refractory CRPS Pain of the Upper Limb: Description of a New Technique and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_1) ◽  
pp. S18-S26
Author(s):  
Thiago Nouer Frederico ◽  
Tiago da Silva Freitas
Keyword(s):  
Neuropathic Pain ◽  
Conservative Treatment ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Case Series ◽  
Pain Syndrome ◽  
Pain Scale ◽  
New Technique ◽  
A New Technique

Abstract Objective Upper limb complex regional pain syndrome is an important cause of chronic pain, and its treatment is challenging. In this pilot case series, we preliminarily evaluated the feasibility, effectiveness, and safety of a new technique for brachial plexus neuromodulation in the treatment of this disease in patients refractory to conservative treatment. Methods Between 2017 and 2018, 14 patients considered to be refractory to optimized conservative treatment were recruited to this study. In the first stage, patients were trialed for seven days with a new technique of implant of the brachial plexus. Patients with ≥50% pain relief in visual analog scale (VAS) score received a definitive implantation in the second stage. Follow-ups were conducted at pre-implant and 12 months using the Neuropathic Pain Scale, SF-32, and the visual analogic scale for pain. Results After the initial trial, 10 patients had a pain reduction of ≥50% and received a permanent implant. At 12-month follow-up, VAS, Neuropathic Pain Scale, SF-12 physical and mental scores improved by 57.4% +/- 10% (P = 0.005), 60.2% +/- 12.9% (P = 0.006), and 21.9% +/- 5.9% (P = 0.015), respectively. Conclusions Our data suggest that this new technique of brachial plexus stimulation may have long-term utility in the treatment of painful upper limb complex regional pain syndrome. New more detailed comprehensive studies should be carried out to confirm our findings in a larger population and to further refine the clinical implementation of this technique.

scholarly journals Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation

2014 ◽  
Vol 37 (3) ◽  
pp. 473-480 ◽  
Author(s):  
Giorgio Stevanato ◽  
Grazia Devigili ◽  
Roberto Eleopra ◽  
Pietro Fontana ◽  
Christian Lettieri ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Peripheral Nerve Stimulation ◽  
New Technique ◽  
Post Traumatic ◽  
A New Technique

scholarly journals Intramuscular Botulinum Toxin in Complex Regional Pain Syndrome: Case Series and Literature Review

2011 ◽  
Vol 5;14 (5;9) ◽  
pp. 419-424
Author(s):  
Robert Schwartzman
Keyword(s):  
Botulinum Toxin ◽  
Pain Score ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Botulinum Toxin A ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Pain Syndrome ◽  
Control Group ◽  
Institutional Review

Background: Pain associated with Complex Regional Pain Syndrome (CRPS) is frequently excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain has not been well described. Objectives: To assess whether intramuscular botulinum toxin injections cause relief of pain caused by CRPS, and to assess the risks of this treatment. Study Design: Retrospective chart review. Setting: Outpatient clinic. Methods: Thirty-seven patients with spasm/dystonia in the neck and/or upper limb girdle muscles. Intervention: EMG-guided injection of Botulinum toxin - A (BtxA), 10-20 units per muscle. Total dose used was 100 units in each patient. Local pain score was measured on an 11-point Likert scale, 4 weeks after BtxA injections. Results: Mean pain score decreased by 43% (8.2 ± 0.8 to 4.5 ± 1.1, P < 0.001). 97% of patients had significant pain relief. One patient had transient neck drop after the injections. Limitations: This is a retrospective study. It lacks a control group and so the placebo effect cannot be eliminated. This study does not provide information on the efficacy of this treatment after 4 weeks. Conclusions: Intramuscular injection of botulinum toxin in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS. The incidence of complications was low (2.7%) Institutional Review: This study was approved by the Institutional Review Board of the Drexel College of Medicine. Key words: Complex regional pain syndrome, botulinum toxin, spasm, dystonia

scholarly journals Intramuscular Botulinum Toxin A (BtxA) in Complex Regional Pain Syndrome

2011 ◽  
Vol 3;14 (3;5) ◽  
pp. 311-316
Author(s):  
Robert Schwartzman
Keyword(s):  
Botulinum Toxin ◽  
Pain Score ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Botulinum Toxin A ◽  
Case Series ◽  
Pain Syndrome ◽  
Control Group ◽  
Retrospective Case ◽  
Toxin A

Background: Pain associated with complex regional pain syndrome (CRPS) is frequently excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain has not been well described. Objectives: To assess whether intramuscular botulinum toxin injections cause relief of pain caused by CRPS, and to assess the risks of this treatment. Study Design: Retrospective chart review. Setting: Outpatient clinic. Methods: Patients: 37 patients with spasm/dystonia in the neck and/or upper limb girdle muscles. Intervention: Electromyography-guided injection of botulinum toxin A (BtxA), 10-20 U per muscle. Total dose used was 100 U in each patient. Measurement: Local pain score on an 11 point Likert scale, 4 weeks after BtxA injections. Results: Mean pain score decreased by 43% (8.2 ± 0.8 to 4.5 ± 1.1, P < 0.001). Ninetyseven percent of the patients had significant pain relief. One patient had transient neck drop after the injections. Limitations: This is a retrospective study; it lacks a control group and therefore the placebo effect cannot be eliminated. This study does not provide information on the efficacy of this treatment after 4 weeks. Conclusion(s): Intramuscular injection of botulinum toxin A in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS in this retrospective case series. The incidence of complications was low (2.7%) Key words: Complex regional pain syndrome, botulinum toxin, spasm, dystonia

Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition

2017 ◽  
Vol 22 (2) ◽  
pp. 3-5
Author(s):  
James B. Talmage ◽  
Jay Blaisdell
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Lower Extremities ◽  
Pain Syndrome ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Type I ◽  
Sixth Edition ◽  
Nerve Entrapments

Abstract Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to rate nerve injuries depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.

In-block lateralization as a new technique for mobilization of the inferior alveolar nerve: a technique case series

2020 ◽  
Author(s):  
Marcos Augusto Tomazi ◽  
Alexandre da Silveira Gerzson ◽  
Angelo Menuci Neto ◽  
André Luciano Pasinato da Costa
Keyword(s):  
Treatment Options ◽  
Inferior Alveolar Nerve ◽  
Case Series ◽  
New Technique ◽  
Autogenous Bone ◽  
Minimal Risk ◽  
Short Implants ◽  
Bone Atrophy ◽  
A New Technique ◽  
Number Of Treatment

The edentulous atrophic posterior mandible is often a great challenge for implant rehabilitation. Although a number of treatment options have been proposed, including the use of short implants and surgical grafting techniques, in cases of severe bone atrophy, techniques for mobilization of the inferior alveolar nerve (IAN) have been shown to be efficient, with good results. Four female patients underwent IAN lateralization for prosthetic rehabilitation of the posterior mandible from 2013 to 2019, with 1 year to 5 years and 4 months of follow-up. This case series describes a new technique for mobilization of the IAN, named in-block lateralization, to facilitate access to the IAN and to reduce nerve manipulation. The implant is immediately installed (allowing nerve lateralization in unitary spaces) and the original mandibular anatomy is restored with autogenous bone from the original bed during the same surgical procedure. When well indicated and well performed, this new approach provides better and easier visualization of the IAN as well as safer manipulation aiming to achieve good results for implant stability and minimal risk of neurosensory disturbances, allowing rehabilitation even in unitary spaces.

Stimulation of Dorsal Root Ganglia for the Management of Complex Regional Pain Syndrome: A Prospective Case Series

Pain Practice ◽  
2014 ◽  
Vol 15 (3) ◽  
pp. 208-216 ◽  
Author(s):  
Jean-Pierre Van Buyten ◽  
Iris Smet ◽  
Liong Liem ◽  
Marc Russo ◽  
Frank Huygen
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Dorsal Root Ganglia ◽  
Dorsal Root ◽  
Case Series ◽  
Pain Syndrome ◽  
Prospective Case Series ◽  
Stimulation Of

The “Mini-Bier’s Block”: A New Technique for Prevention of Tourniquet Pain During Axillary Brachial Plexus Anaesthesia

1994 ◽  
Vol 19 (3) ◽  
pp. 347-349 ◽  
Author(s):  
N. K. JAMES ◽  
C. T. K. KHOO ◽  
R. H. FELL
Keyword(s):  
Brachial Plexus ◽  
Regional Anaesthesia ◽  
Low Dose ◽  
New Technique ◽  
Controlled Study ◽  
Axillary Block ◽  
Pneumatic Tourniquet ◽  
Axillary Approach ◽  
A New Technique ◽  
Local Block

Tourniquet cuff pain is a significant cause of morbidity following regional anaesthesia of the upper limb. We describe a simple new technique for effectively anaesthetizing the area under a pneumatic tourniquet (the “mini-Bier’s block”), which permits comfortable surgery under axillary block anaesthesia even if the local block is incomplete. We report a controlled study of 40 patients in whom statistically significant tourniquet cuff pain relief was obtained in patients receiving an additional low-dose intravenous injection of local anaesthetic localized beneath the cuff. This technique ensures that the safe axillary approach to the brachial plexus can always be used with avoidance of pain from the pressure of the tourniquet cuff.

Sign in / Sign up

Export Citation Format

Share Document