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When should sympathetic blocks be considered for treatment of neuropathic pain? Sympathetic blocks such as the classic stellate ganglion block and lumbar sympathetic block (depending on affected region) should be considered when CRPS or sympathetic involvement in pain is suspected. CRPS, types 1 and 2, may have significant sympathetic involvement. Aside from typical neuropathic pain …

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Does Epidural injections prevent postherpetic neuralgia They might. Multiple randomized-controlled trials have shown at least some modest reduction in pain and allodynia, with a single epidural injection of local anesthetic and steroid soon after onset of HZ, but prevalence of chronic pain 6 months later was not significantly reduced. However, results of another randomized controlled …

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How useful are epidural injections for radicular pain? This could be the subject of a 50-page chapter with varying conclusions, but in general epidural injections, particularly with local anesthetic and steroids, are useful. A recent review of randomized-controlled trials concluded a modest effect size lasting less than 3 months most often when using a transforaminal …

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Indications for epidural steroid injections in neuropathic pain Epidural steroid injections (ESIs) may be useful in treatment of radicular pain as well as pain related to acute HZ or PHN. Some studies have shown a favorable response in patients with prolonged PHN to a series of epidural injections with local anesthetic and steroid. The most …

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When are peripheral nerve blocks useful for neuropathic pain? In patients with focal peripheral neuropathic pain, diagnostic nerve blocks may be used to determine if a particular nerve is involved in a patient’s symptoms. The response to injection can help determine candidacy for therapeutic blocks (with steroids or a series of injections), neuroablative techniques, or …

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Is there a role for procedural interventions in neuropathic pain? Yes. Procedures are particularly appropriate when trials of oral medications have failed to provide adequate relief or medications cause undesirable or intolerable side effects. Peripheral nerve blocks, neuraxial nerve blocks, sympathetic blocks, implanted spinal cord stimulators, and implanted intrathecal catheters may all have a role. …

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Is capsaicin still being used for neuropathic pain? Yes. Capsaicin is a naturally occurring compound that selectively depletes peptide neurotransmitters (such as substance P) from small-diameter primary afferent neurons and is toxic to the TRPV1 receptors on small axons responsible for thermal pain. Capsaicin cream has been used in PHN and in neuropathy due to …

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