Pain practice : the official journal of World Institute of Pain
-
Transdermal buprenorphine is an effective analgesic for a variety of pain conditions. Traditionally, neuropathic pain is treated with medications such as tricyclic antidepressants or anticonvulsants, with opioid medications as second or third-line agents. We present two different painful conditions of presumed neuropathic origin, with complex etiopathogenesis, which were successfully treated with buprenorphine. The results of treatment of these neuropathic pain syndromes with buprenorphine are encouraging, suggesting that it might represent a valid alternative to standard approaches for central neuropathic pain.
-
Pulsed radiofrequency treatment has been described as a nonablative alternative to radiofrequency thermocoagulation for the management of certain chronic pain syndromes. We present our first three patients with long-standing cluster headaches who were treated with pulsed radiofrequency to the sphenopalatine ganglion. All three patients have had cluster headaches for more than 10 years' duration and experienced minimal relief with conservative treatment. ⋯ Quantitative sensory testing consisting of allodynia testing, pressure-pain thresholds, electrical pain thresholds, and conditioned pain modulation (CPM) response testing were used to monitor their sensory processing changes before and after the procedure. From this case series, it might be that cluster headache patients with an impaired CPM response with or without signs of allodynia will respond less favorably to interventional treatment. Further studies are required to validate this hypothesis.
-
Two important groups of disorders result from an insufficient blood supply to the extremities: critical vascular disease and the Raynaud's phenomenon. The latter can be subdivided into a primary and a secondary type. Critical ischemic disease is often caused by arteriosclerosis due to hypertension or diabetes. ⋯ In view of the degree of invasiveness and the costs involved, this treatment should preferably be applied in the context of a study and with the use of transcutaneous pO(2) measurements. In case of primary Raynaud's, life style changes are the first step. Sympathectomy can be considered as a treatment of Raynaud's phenomenon (2C+), but only after multidisciplinary evaluation of the patient and in close consultation with the patient's rheumatologist, vascular surgeon or internist.