Pain practice : the official journal of World Institute of Pain
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Angina pectoris, cardiac pain associated with ischemia, is considered refractory when optimal anti-anginal therapy fails to resolve symptoms. It is associated with a decreased life expectancy and diminishes the quality of life. Spinal cord stimulation (SCS) may be considered for patients who have also undergone comprehensive interventions, such as coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) procedures. ⋯ SCS can be an alternative to surgical intervention in a selected patient population. In addition, SCS is a viable option in patients in whom surgery is not possible. SCS is recommended in patients with chronic refractory angina pectoris that does not respond to conventional treatment and in whom revascularization procedures have been attempted or not possible, and who are optimized from a medical perspective.
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Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. ⋯ Pelvic pain due to cancer can be managed with plexus hypogastricus block and the saddle or lower end block may be a last resort for patients suffering with perineal pain. Back pain due to vertebral compression fractures with or without pathological tumor invasion may be managed with percutaneous vertebroplasty or kyphoplasty. All these interventional techniques should be a part of multidisciplinary patient program.
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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.
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Chronic pancreatitis is defined as a progressive inflammatory response of the pancreas that has lead to irreversible morphological changes of the parenchyma (fibrosis, loss of acini and islets of Langerhans, and formation of pancreatic stones) as well as of the pancreatic duct (stenosis and pancreatic stones). Pain is one of the most important symptoms of chronic pancreatitis. The pathogenesis of this pain can only partly be explained and it is therefore often difficult to treat this symptom. ⋯ Radiofrequency treatment, being less invasive than spinal cord stimulation, could be tested prior to considering spinal cord stimulation. There are several other treatment possibilities such as endoscopic or surgical treatment, pancreatic enzyme supplementation and administration of octreotide and antioxidants. All may have a role in the management of pain induced by chronic pancreatitis.