Pain relief after procedure.

    
      Re: Pain relief after procedure.
    


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Posted by CCF Neuro MD on May 27, 1997 at 10:26:59:

In Reply to: Pain relief after procedure. posted by Enzo Curcio on May 20, 1997 at 11:52:26:

: A couple of  years ago I  was involved in a road accident
  which left me amongst other things with severe pain in
  upper neck. I also received an injury that affected my
  short term memory area of the brain which necessitated my
  relearning how to read and write etc. Mostly I have recovered
  but still the pain persisted in my neck (sometimes
  excruiating). Three weeks ago I underwent a procedure
  medically defined as a percutaneous facet denarvation.
  This procedure was performed on my C2 and C4 nerves.
  Unfortunately the pain seems to have increased since
  this procedure and I am even at the point where my GP can
  only subscribe narcotic type pain killers which although
  easing the discomfort for a couple of hours have most
  unpleasant side effects. May I respectfully solicit your
  opinion on the above and would welcome any suggestions
  you may have
  thank you
  Enzo Curcio - Ajax Ontario Canada
=============================================================================================
Hello Enzo,
I would like to start by saying that your story is not an uncommon problem that is seen by neurologist.  It is however a complicated issue both in obtaining the correct diagnosis as well as finding an effective management for the pain.  A clear understanding of the  mechanism of pain production is critical for any threatment strategy to work.  The structures that could mediate pain in a case like yours include bony structures, nerve roots, spinal cord, and musculotendonous structures.  In addition to a careful history and physical examination, certain test such as imaging studies like MRI and CT scans in addition to neurophysiologic test like EMG are usefeul when indicated.  The fact that you did not get a good response from the initial procedure suggests that those specific nerve roots were not responcible for mediating the pain you were experiencing.  What might be helpful at this point in your case is to revisit the issue of diagnosis before embarking on any further invasive procedures.  Cases of cervical radiculopathy (pain caused by the compression of nerve roots) can respond to treatments like physical therapy with cervical traction.  Other devises such as TENS unit may also be helpful.  Biofeedback can also help in controlling pain at the psychologic level.  These are just some of the treatment approaches but a clear understanding of the mechanism of pain is the first step before creating a treatment strategy.  Good luck.