The use of neural blockade for the diagnosis and treatment of persistent pain is a well established practice. Regional anesthesia techniques perfected over the past century are commonly used in our clinics to diagnose and treat difficult pain problems. Since pain impulses are transmitted by specific nerves, blockade of these nerves can give useful information as to the sources for pain. For instance, by blocking somatic (body wall) nerves, we can sometimes determine whether pain is originating within the body wall structures as opposed to internal organ structures. This knowledge can improve accuracy in diagnosing pain syndromes and guide surgical therapy or interventional pain treatment.
Treatment for Neuropathic Pain
Injury or damage to peripheral nerves can result in neuralgia, neuritis, and certain neuropathic pain states. “Neuropathic pain” implies that pain is emanating from damaged nerves that are sending inappropriate pain impulses in the absence of an underlying tissue injury. Pain from these damaged nerves is sometimes mistaken for other medical conditions, and this confusion can lead to ineffective medical therapy and unnecessary surgery. An example of this, is a patient with persistent lower quadrant abdominal pain who undergoes repeated surgery on internal organs without improvement, and he or she is later found to have body wall nerve entrapment as the true source for pain.
Identifying Sources of Nerve Pain
Identification of damaged peripheral nerves as the source for ongoing pain is possible using nerve block techniques. Repeated blockade of malfunctioning peripheral nerves with solutions containing local anesthetic and/or steroid may help to reverse abnormal neural sensitivity and end pathological pain sensation. In certain cases, pathological nerves can be permanently destroyed with injection of neurolytic substances, cold lesions (cryoanalgesia), or heat lesions (radiofrequency nerve ablation).
Nerve Blocks and Acute Pain
A number of acute pain conditions such as pain from rib fractures and post-surgical pain can also be controlled well with nerve block techniques in the outpatient setting. Nerves can be blocked in series with long acting local anesthetics or, conversely, continuous infusion techniques can be used to provide continuous, prolonged neural blockade.
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