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KMID : 0614520040140010088
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Journal of the Korean Pain Research Society
2004 Volume.14 No. 1 p.88 ~ p.93
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Neural Block and Partial Radiofrequency Lesioning on Dorsal Root Ganglion for the Management of Chronic Persistent Postherpetic Neuralgia
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Park Jung-Yul
Kim Sang-Dae
Kim Sang-Hyun
Kim Se-Hoon
Lim Dong-Jun
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Abstract
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Objective: Substantial number of patients with postherpetic neuralgia experience chronic, persistent pain of neuropathic nature despite various treatments available. Thus, successful management of these patients is very challenging even to those specializing pain. The object of this study was to validate usefulness of dorsal root ganglion (DRG) blocks followed by percutaneous radiofrequency (RF) lesioning in thes chronically disabling patients.
Materials & Methods: A total of 40 patients, 26 males and 14 females, aged between 47 to 72 years old were included in this study. All patients suffered from severe, intractable postherpetic neuralgia, all in the thoracic dermatome, more than 6 months (average 14.6 mos). These pains became refractory to medications and peripheral nerve blocks performed elsewhere. DRG blocks and RF DR lesioning were performed in corresponding levels under local anesthetics. First, with patient prone, DRGs were targeted with 22 G electrodes, with 5-mm bared tips, and these were confirmed radiographically with injection of contrast dye. Then, 3cc mixture of steroid and lidocaine, in case with blocks, were injected transforaminally. RF lesioning was done followed by physiologic testings and instillation of 0.5 ml of lidocaine. Lesions comprised of 42oC initially, for the testing, then 67 degrees for 90 seconds for final lesioning. Successful pain relief was considered when more than 50% of pain relief from previous pain. All patients were followed more than six months.
Results: All patients tolerated well from both procedures. Initial diagnostic/therapeutic DRG blocks showed more than 50% of pain relief in 32 patients, but with varying degree in duration of pain relief, ranging 2 days to 3 months. Average 2.5 blocks were performed in these patients before RF lesioning was performed. Four of 8 patients, who showed no significant pain relief initially showed more than 50% of pain relief from second procedure. Remaining four patients showed no change. In overall, DRG blocks followed by RF DRG lesioning provided significant pain relief in 32 of 40 patients (80%) for more than 6 months. Two of these patients underwent radiofrequency thalamotomy with successful results. Remaining 2 patients who showed about 30∼40% pain relief are under consideration for either DREZtomy or spinal cord stimulation but refused any further therapeutic modalities. There were no complications related to procedures. However, 6 patients complained transient exacerbation of pain or soreness that persisted for about a week.
Conclusions: Series of DRG blocks and percutaneous RF DRGangliotomies seemed to provide significant pain relief in majority of patients with intractable postherpetic neuralgia involving thoracic region. Therefore, they should be considered next when conservative measurements, including peripheral nerve blocks, fail to relieve pain or become refractory.
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KEYWORD
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Postherpetic neuralgia, Dorsal root ganglion, Nerve block, Radiofrequency, Lesioning
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