Craig R. DuBois, M.D.
The Pain Evaluation & Treatment Center
7307 Creekbluff Drive
Austin, TX 78750
512-346-6969
http://www.paineval.net/our_physicians.nxg
Transcript: Role of injections and nerve blocks
The other thing that’s developed very recently is the role of injections and nerve blocks and treatments like that. We talked a little bit about the medication being applied topically and that kind of brought a little bit more thought process to us of treating the area out where the surface pain is.
We see more and more people having this neuropathic pain which means injury in some fashion to the branches of the nerve. Classic trigeminal neuralgia we think of as being in the brain, in the brainstem or deep in the nerve bundles. And the neuropathic we think of being more out on the surface.
Well, when you start thinking more out on the surface area or closer to the surface, it becomes more reachable with the topical gels that we talked about putting on. And the other thing you can do is to start approaching those areas with injections or other techniques.
And one of the other topics we talked about was Botox. Well, it’s in the area where it’s injected is where it works, same thing for nerve blocks.
You can do localized nerve blocks into the areas where the nerves are coming close to the surface. In what we call V2 or second division, the nerve comes right out under the eye and then spreads onto the cheek. And I can tell you when I started practice and was in training, we kind of left all that alone. You didn’t want to mess with these trigeminal neuralgia patients because they’re tricky, they’re touchy. Well, indeed, just air on the surface of the area will bother them.
But we’ve found over time that some of these neuropathics had some injury, previous surgery, we could go in and using a Novacaine type of medicine in some of the longer acting forms sometimes get a reduction in the signal level. And it’s kind of like when you listen to squelch or speakback on the radio or the guitars and that screeching. If you can just turn the volume down, you can stand it. You know. Or my neighbor kid in the garage band that has screeching, scratching noise, if I could just turn his volume down, I could stand it.
So we found that if we approach the nerves out on the surface underneath the surface where we can get to them with a small needle, we can inject medicines and find a benefit. Now the big problem is a lot of these medicines for work hours, if at best several days.
But that’s lead us to doing other things such as some of the radiofrequency procedures. You can now start to adjust how much heat you put in there. It used to be thought that you had to blotto the nerve, just basically you know boil it to get it to stop signaling. In some of them such as ganglions, that’s true. In some of these peripheral nerves we’ve found that by partial lesioning, a partial heat treatment can give months of benefit. Maybe they don’t get two years of benefit but two to three months of reduction in pain is a good result for that person especially considering it’s a low risk of causing things like one thing we’ll talk about anesthesia dolorosa or increasing the pain from a partial lesion is very, very rare in my experience.
I tell patients one of the ways to do it is you stick your toe into the water before you dive into the water. Let’s see how hot it is. You know and the same thing for these. You can do a light lesion with the temperature and they might get I’ve had as short as a week. Well, that person’s happy because it didn’t cause more problems and it gave them a little relief. It gave them a chance to test the water so to speak. And so what we find is by doing that, and we say, okay, we’ll come back and do a little more, get a little bit hotter. And each time, you go a little bit more. And the patient builds comfort. They find that this isn’t so scary. It wasn’t a hard thing to do. It’s a very easy procedure to get through. And the biggest problem is yeah; you have to do it a couple of times over but for a comfortable patient going through a procedure, that’s well worth the cost.