Repetitive Sciatic Nerve Blocks May Reduce Nerve Pain

Dear Pain Matters blog readers,

Feature Image sourced from:

https://www.webmd.com/back-pain/ss/slideshow-low-back-pain-overview

Repetitive sciatic nerve blocks may offer substantial pain relief for some patients with nerve pain.

DETAILS

A 50-year-old woman (let’s call her ‘Jane’) suffered ongoing nerve pain in her left lower limb following surgery to remove a schwannoma* on her left S1 nerve root (aka sciatica nerve schwannoma).
Decades earlier aged only 27, Jane suffered ‘electric-like pain’ during intimacy.  Shortly afterward, surgery was performed to remove a cyst on her left ovary.  Despite surgery and nonsteroidal anti inflammatory drugs (NSAIDs), her pain persisted.
Several years later, a 3 cm surgical incision was performed to remove her left S1 nerve root at the plexus including a schwannoma.
Post-surgery, Jane endured pain upon sitting and touch.  She also had a limp in her left leg.
Jane was prescribed NSAIDs, antidepressant and pregabalin.  Despite these medications,  Jane suffered ongoing mild pain.  She also had intense pain at rest and movement as well as severe allodynia upon palpation in the area between S1 to L5 (VAS from 3 to 10).
Jane displayed mild motor weakness during nerve testing of her left lower leg (i.e. during leg abduction, foot eversion, plantar and toes flexion and in the hip extension).
Jane also had drastically reduced sensation in her foot, lower leg and thigh and buttocks.
A sciatic nerve block comprising an anesthetic mixture (20 mL) was injected at the ‘pain trigger point’ (located 1 cm above the midline of the incision).
RESULTS OF SCIATIC NERVE BLOCK
Guess what happened next??
Jane enjoyed immediate pain relief after this sciatic nerve block (VAS 1/10), after suffering years of pain!!
The sciatic nerve block’s pain relieving effects lasted 15 days.  Despite her nerve pain returning 15 days later, Jane’s pain had lost its original intensity (VAS decreased to 3/10).
To better manage Jane’s nerve pain, a repetitive sciatic nerve block was prescribed.
SUMMARY
Some nerve pain patients may benefit from repetitive sciatic nerve blocks.

Sabina Walker

Blogger, Pain Matters (in WordPress)

 

*Usually benign in nature, a schwannoma is a nerve sheath tumour that develop from the Schwann cell.

REFERENCES

(1) Naja Z et al. Repetitive nerve block for neuropathic pain management: a case report. Scand J Pain (26 Jan 2018);18(1):125-127.

doi: 10.1515/sjpain-2017-0155.
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A Single Nerve Block May Result in Reduced Migraine Days and Increased Serotonin

Dear Pain Matters blog readers,

Feature Image sourced from:

http://upcouture.com/en/blog//do-you-have-regular-headaches-or-migraine-watch-out-to-relax-your-neck-and-upper-back-muscles-and-adopt-a-good-posture

INTRODUCTION

Here is some good news for migraine sufferers:

single nerve block called a Greater Occipital Nerve Block (GON block) may lead to reduced migraine days and increased serotonin!

DETAILS OF MIGRAINE STUDY

Specifically, an Italian study involving 17 migraine patients and 19 healthy controls found that a single Greater Occipital Nerve Block (GON block) significantly reduced the total number of migraine days per month by 35%.

The GON block offered the biggest migraine relief in 11 of 12 patients who also endured Medical Overuse Headache (MOH).  Medical Overuse Headache results from medication overuse.

Once the GON block’s effects wore off, episodic migraine returned in 8 of 17 patients.

It is thought that serotonin deficiency may contribute to migraines.

Thus, it is likely that enhanced serotonin release and increased central serotonergic tone resulted in migraineurs who enjoyed fewer migraine days following a single GON block.

The slope of the intensity dependence of auditory evoked potentials (IDAP) was significantly flatter in those patients who benefited from the GON block.  Decreased IDAP values are linked with stronger central serotonergic tone.

A flatter IDAP slope as well as migraine relief offered by a single GON block are suggestive of changes in the brain (i.e. plastic brain changes, neuroplasticity) (Viganò et al, 2018).

SUMMARY

Migraineurs may benefit from a GON block.

Given that a single GON block led to 35% fewer migraine days per month and given that increased serotonin occurred (as indicated by a flatter IDAP slope), migraines may be (partly or fully) centrally mediated in the brain by serotonergic mechanisms.  Finally, these mechanisms may be modulated by a GON block.

A flatter IDAP slope as well as migraine relief offered by a single GON block are suggestive of changes in the brain (i.e. plastic brain changes, neuroplasticity) (Viganò et al, 2018).

All this is good news for migraine sufferers!

Sabina Walker

Blogger, Pain Matters (in WordPress)

REFERENCE

Viganò et al. Neurophysiological correlates of clinical improvement after greater occipital nerve (GON) block in chronic migraine: relevance for chronic migraine pathophysiology. The Journal of Headache and Pain (Dec 2018). 19: 73: pages 1-9.

https://link.springer.com/content/pdf/10.1186%2Fs10194-018-0901-z.pdf