Integrated Pain Management

Nerve Blocks

Celiac Plexus Nerve Block

The celiac plexus is found on either sides of the aorta around the first lumbar vertebra. It supplies sensation to organs such as the kidneys, the liver, pancreas, stomach, gall bladder and the gut. This therapy is performed every 2 to 4 weeks for 3 blocks and is administered for:

> Acute and chronic abdominal pain

> Surgery involving the upper part of the abdomen

> Crohn’s disease

> Pancreatic cancer

> Acute and chronic pancreatitis

Ganglion Impar Blockage

The Ganglion Impar is located anterior to the sacricoccygeal junction and represents the end of the sympathetic pain.

There are different blockades available for purposes of blocking this particular nerve including the bent needle technique that is placed at the anococcygeal ligament level.

Because of the closeness of the rectal canal to this site, the safest and easiest method is one involving the sacrococcygeal transverse.

The injection of a contract agent with the guidance of fluoroscopy is used as a confirmation of proper placement of the needle.

Nerve Blocks

Nerve blocks treatment method is typically performed under local anesthetics and steroids if the pain is nonmalignant like perirectal pain or coccygodynia.

Neurolytic blockades are only recommended in cases involving malignant pain and only performed after the diagnostic block.

The benefit of the Ganglion Impar over the neurolytic procedure for cases of rectal pain is that there are no side effects that interfere with the bladder or bowel functions

Neurolytic Blocks

Neurolotic blocks are injections of phenol or alcohol around groups of nerves with an aim of relieving pain on a long-term basis. Phenol and alcohol will cause injury to the involved nerves and will alleviate the pain and symptoms at a greater magnitude than local anesthetics.

After the damage of the nerves, the body will try to counter this by repairing them but this can take anything between a few months and a number of years and will vary with patients.

In most cases, when the nerves are repaired, the experienced pain will be greater than what was initially felt and this is why this treatment is mostly used for cancer terminal cancer patients when other modalities have been tried.

In most cases, the treatment has been termed as permanent but this may not be the case. In cases where the pain returns, the block side may be repeated.

The difference between this procedure and temporal local anesthetics is the medication used. This treatment is mostly administered to patients of ovarian cancer, colon cancer, and pancreatic cancer among others.

Gasserian Ganglion Block

Gasserian ganglion blocks are medical procedures involving the application of small doses of local anesthetic into bundles of nerves supplying sensation to the scalp and to the face.

These nerve blocks are used in relieving the pain perceived by patients of cancer, trigeminal neuralgia, and any other syndrome that causes facial pain. In patients who are suffering from cancer, there can be medication used in killing the involved nerve bundles but this procedure can never be used if the patient does not have cancer.

The benefit of gasserian ganglion blocks is that the relief felt by the patients is instant. The relief will last for about 12 hours but in cases where medication used kills the nerves, the relief will be experienced after 1 or 2 days but the effects will last for a period between 3 and 6 months.

The understanding of primary headaches is more complex that that of secondary headaches. The exact root causes of tension headaches and migraines are not known though there are different theories that have attempted to explain the mechanism behind these headaches.

Lumbar Sympathetic Block

The lumbar sympathetic nerves are located from the 1st to the 5th lumbar vertebrae, which is the region around the lower back. These nerves are responsible for supplying sensation to the lower extremities.

The benefit of this treatment is the improvement of the skin lesion healing and pain relief. Patients will also experience improved blood circulation in the lower part of the body.

Neurolytic Posterior Thoracic Sympathetic Block

This is a nerve block recommended for the relief of severe pan involving the sympathetic mediated pain in the upper extremities such as causalgia or reflex sympathetic dystrophy. This treatment is also successfully used for relieving chest pain.

In this procedure, small amounts of aqueous phenol or alcohol are injected carefully on a targeted area in the upper back with an aim of killing the nerves. This process is handled with the guidance of a CT scan to ensure that the medication is injected in the right place for optimal relief.

Stellate Ganglion Block

The Stellate nerve ganglion is located in the neck region on both sides of the trachea. This nerve is responsible for the control of pain signals and blood flow to the face, head and neck.

The stellte ganglion block is used in the treatment of vascular instability and different pains that are related to the following:


> Herpes zoster or shingles 

> Phantom limb experienced after amputation 

> Hyperhidrosis 

> Shoulder-hand syndrome 

> Thrombosis 

> Scleroderma Paget’s disease 

> Reflex sympathetic dystrophy of the head

The benefits of this treatment are the reduction of the pain felt within 20 minutes but this can be delayed. The patients will experience a temperature change in the affected area and the circulation will be increased.

 It is only with repeated injection that the treatment is considered permanent and this will involve anything between 5 and 8 injections.

Superior Hypogastric Plexus Block

The superior hypogastric block is a recent addition to the treatment of both malignant and non-malignant pelvic pain. This treatment was invented in 1989 by Ricardo Plancarte.

The plexus is located in the anterior to the L5 vertebra and contain the postganglionic sympathetic fibers and affered pain fibers. This plexus is the source of innervations to the rectum, vagina, bladder, vulva, prostate, uterus, and perineum. This means that pain felt in any of the mentioned areas can be alleviated through the blockade of these nerves.

The procedure is performed under the guidance of fluoroscopic or CT scans for proper needle placement. This treatment has shown positive results in the management of pelvic pain and is recommended in cases where oral medications have failed to show positive results.

Integrated Pain Management

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