Aa
Anyone heard of spheno-palatine ganglion blocks?
Went to see the pain management across from the MS Institute on Friday. The doc sees a lot of MS patients for chronic pain so there is a modicum of trust there. My MS neuro (from anther institute referred me there.
When I went for my first visit, he perform a spheno-palatine injection via the nasal cavity. Not too bad , just uncomfortable. According to the doc this ganglion (supply of nerve cell bodies). It innervates the the fifth cranial nerve which affects the face and trigeminal nerves among others.
The treatment plan was 3 injections a week apart and if these were successful then 3 ketamine infusions, each a week apart. I understood how this could possibly improve my face pain, migraines and trigeminal neuralgia but was confused by how it would help the bone pain in my legs. His response it this ganglion innervates the spinal column and carries nerves to the other parts of the body. I wasn't thoroughly convinced (always the skeptic) but was game for anything involving decreased face pain and headaches. He tended to bombards DH and me with a large amount of information in a short amount of time.
So, the injection with Marcaine went well and lo and behold the bone pain in my leg disappeared. Granted it could have been a placebo effect , but who cares as it stayed away until today. Today ,it's all back with a vengence including the dreaded increased fatigue.
Has anyone heard of this technique or am I being fed a line of bull. Any and all comments welcome!
Ren
When I went for my first visit, he perform a spheno-palatine injection via the nasal cavity. Not too bad , just uncomfortable. According to the doc this ganglion (supply of nerve cell bodies). It innervates the the fifth cranial nerve which affects the face and trigeminal nerves among others.
The treatment plan was 3 injections a week apart and if these were successful then 3 ketamine infusions, each a week apart. I understood how this could possibly improve my face pain, migraines and trigeminal neuralgia but was confused by how it would help the bone pain in my legs. His response it this ganglion innervates the spinal column and carries nerves to the other parts of the body. I wasn't thoroughly convinced (always the skeptic) but was game for anything involving decreased face pain and headaches. He tended to bombards DH and me with a large amount of information in a short amount of time.
So, the injection with Marcaine went well and lo and behold the bone pain in my leg disappeared. Granted it could have been a placebo effect , but who cares as it stayed away until today. Today ,it's all back with a vengence including the dreaded increased fatigue.
Has anyone heard of this technique or am I being fed a line of bull. Any and all comments welcome!
Ren
Wow, that is the best relief out of a pain management clinic that I have ever heard, and I have heard great stories. I am so pleased for you.
My pain is lessening as I go up on the carbamazepine. I'm at 300mg tid and the pain is just after eating a meal. My minion gets in a few odd whacks here and there, but it's tolerable. I thought it was just TMJ pain when it started a few months ago, because it started the day ofter teeth cleaning. But, gradually the pain spread beyond the joint and is greatest on the upper lip toward my cheek.
I'm so happy for you!
Quix
My pain is lessening as I go up on the carbamazepine. I'm at 300mg tid and the pain is just after eating a meal. My minion gets in a few odd whacks here and there, but it's tolerable. I thought it was just TMJ pain when it started a few months ago, because it started the day ofter teeth cleaning. But, gradually the pain spread beyond the joint and is greatest on the upper lip toward my cheek.
I'm so happy for you!
Quix
Hi All,
UPDATE ON SP BLOCKS ; I apologize for such a long time in between posts here. Life happens when preparing for the holidays, helping my daughter study for the PCAT and all the little minute details that seem to swallow up time when you're not watching.
My last spheno-palatine block was 12 and 1/2 weeks ago and it's still holding. That includes dental work (2 on-lays) and other medical testing. I'm just now beginning to have signs of the blocks wearing off. Small, (compared to those pre-treatment) zaps and zings and one odd day 2 weeks ago with the burning, aching, hammer pounding pain but this was during a migraine.
I plan on discussing the continuation of these blocks as needed. I believe he said every 3-9 months was the average. I have tapered down on my Trileptal that I was using to half the dosage and completely came off another drug the pain doc gave me for pain control.
The ketamine infusions are now 3 weeks apart and the dose is gradually increased. My last one is next week. The side effects are quite tolerable and my constant throbbing leg pain is only an occasional visitor. I am pleased with this result.
I didn't go into this expecting perfect and total relief and I haven't achieved that nirvana. I am totally pleased with the reduction in my pain levels. On a 1-10 scale with 1 being the best and 10 being the worst, I started these treatments with an average daily score of 7-8 depending how much additional medicine (narcotics to sleep) I took. I now rate my face and leg pain at a 1 or 2 depending on how much activity I have done and on a shorter list of medications.
Please feel free to ask questions. I'm sure I didn't explain some things fully, especially to the newcomers who may not have read my old posts.
Ren
UPDATE ON SP BLOCKS ; I apologize for such a long time in between posts here. Life happens when preparing for the holidays, helping my daughter study for the PCAT and all the little minute details that seem to swallow up time when you're not watching.
My last spheno-palatine block was 12 and 1/2 weeks ago and it's still holding. That includes dental work (2 on-lays) and other medical testing. I'm just now beginning to have signs of the blocks wearing off. Small, (compared to those pre-treatment) zaps and zings and one odd day 2 weeks ago with the burning, aching, hammer pounding pain but this was during a migraine.
I plan on discussing the continuation of these blocks as needed. I believe he said every 3-9 months was the average. I have tapered down on my Trileptal that I was using to half the dosage and completely came off another drug the pain doc gave me for pain control.
The ketamine infusions are now 3 weeks apart and the dose is gradually increased. My last one is next week. The side effects are quite tolerable and my constant throbbing leg pain is only an occasional visitor. I am pleased with this result.
I didn't go into this expecting perfect and total relief and I haven't achieved that nirvana. I am totally pleased with the reduction in my pain levels. On a 1-10 scale with 1 being the best and 10 being the worst, I started these treatments with an average daily score of 7-8 depending how much additional medicine (narcotics to sleep) I took. I now rate my face and leg pain at a 1 or 2 depending on how much activity I have done and on a shorter list of medications.
Please feel free to ask questions. I'm sure I didn't explain some things fully, especially to the newcomers who may not have read my old posts.
Ren
I'm not sure that I am understanding all of this. I have had MS for 13 years and many complications, but currently am suffering from TN in the most extreme way! I have tried many things but never heard of anything like this. Of course, at first I thought that it was my teeth so I have 3 root canals, which probably made matters worse. After the root canals I had a Rhizotomy where they go in and deaden the nerve, which did not help. Next I was sent to the pain center at Rush University in Chicago. There I began many different medications with no relief, also tried a steroid injection in the jaw and the neck. With no relief, but my persistence I tried having the CCSVI treatment and found my energy increased but still no relief from the pain.
I am interested in any suggestions that are made. I refuse to take NO for an answer there has to be something that relieves this pain. My teeth no longer feel like teeth. I am unable to stick a q-tip in my right ear because of the pulling in my front lower teeth. I can't eat and have to be careful in what I drink due to the tingling and burning sensation. Brushing my hair or teeth has become a task and have to talk myself in to doing it.
I would appreciate any suggestions or ideas regarding this.
Thank you
Jolie
I am interested in any suggestions that are made. I refuse to take NO for an answer there has to be something that relieves this pain. My teeth no longer feel like teeth. I am unable to stick a q-tip in my right ear because of the pulling in my front lower teeth. I can't eat and have to be careful in what I drink due to the tingling and burning sensation. Brushing my hair or teeth has become a task and have to talk myself in to doing it.
I would appreciate any suggestions or ideas regarding this.
Thank you
Jolie
Right along with this, you might begin a program of Mindful Meditation to accentuate any relief that is being brought by the treatments.
Q
Q
>>I say go for it!
no kidding!
ren,
where is this place located? i'd like to present it to my doc for my pain syndromes. one of my chief complaints regarding my spine and MS.
thx
no kidding!
ren,
where is this place located? i'd like to present it to my doc for my pain syndromes. one of my chief complaints regarding my spine and MS.
thx
Thanks for your input!!! Now what the doc said makes more sense. He did say the brain would reset and you have just given me the key piece of info I was missing. I was unaware that once the pain was relieved, the brain could "reset". It also explains why they do each treatment several times.
He did tell us that but with my raging pain and the deluge of info , it was hard to keep up, much less ask specifics. Don't get me wrong, I DO like this doc, he was the saint who did my blood patch on Dec 26th without grumbling and his technique then was excellent.
As for the side effects of the ketamine, I get Valium in hopes of reducing these side effects.
Yes, this doc is very skillful and respected. He gets referrals from all over Atlanta he told us. Now I know why.
Quix, once again, thank you for clearing up the muddled information puddle!
He did tell us that but with my raging pain and the deluge of info , it was hard to keep up, much less ask specifics. Don't get me wrong, I DO like this doc, he was the saint who did my blood patch on Dec 26th without grumbling and his technique then was excellent.
As for the side effects of the ketamine, I get Valium in hopes of reducing these side effects.
Yes, this doc is very skillful and respected. He gets referrals from all over Atlanta he told us. Now I know why.
Quix, once again, thank you for clearing up the muddled information puddle!
This is soooooooo interesting. Paindocs DO have a lot of tricks up their sleeves. Also, the repetition of successful pain tretments tends to have a progressively lingering effect on pain. I don't understand pain and the gateway theories so well, but also, once a pain has been relieved, sometimes it's like the brain "resets" and the pain level reduces chronically. that is always the hope, at least.
Yes, ketamine is a dissociative anesthetic, but they have learned how best to use it so people do not get the "acid trips" and flashbacks. If I had the kind of pain you and Michelle have, I would not hesitate to get the full course of treatment if I felt comfortable with the doctor. Your descrition indicates this doc is very skillful and respected by others.
I say go for it!
Quix
Yes, ketamine is a dissociative anesthetic, but they have learned how best to use it so people do not get the "acid trips" and flashbacks. If I had the kind of pain you and Michelle have, I would not hesitate to get the full course of treatment if I felt comfortable with the doctor. Your descrition indicates this doc is very skillful and respected by others.
I say go for it!
Quix
bump to keep this up near the top - there are many people here who perhaps would benefit from this treatment, but don't know a thing about it.
I guess I am really going to have to look for that brochure. Perhaps it was a procedure that sounded like a similiar name? I will try to check tomorrow, or I guess later today. I am up @ 2:30 in the morning with a severe back/leg ache. I think I am getting the flu perhaps? I hope not.
Michelle
Michelle
Mary,
Yes he is also an anesthesiologist or else he would NOT be giving ketamine IV in a doctor's office (although, it is connected to a hospital).
Michelle,
I agree with Mary, the end result may be the same but why not do the q-tip trick when that will cause NO bleeding?
ren
Yes he is also an anesthesiologist or else he would NOT be giving ketamine IV in a doctor's office (although, it is connected to a hospital).
Michelle,
I agree with Mary, the end result may be the same but why not do the q-tip trick when that will cause NO bleeding?
ren
Now I remember. Is the DO pain management specialist also an anesthesiologist?
Michelle, are you sure your last pain specialist was talking about this same procedure? Why stick a needle through your face when a swab up the nose will do the trick? Seems like a question worth askin'.
Mary
Michelle, are you sure your last pain specialist was talking about this same procedure? Why stick a needle through your face when a swab up the nose will do the trick? Seems like a question worth askin'.
Mary
Ah yes, the holistic DO. Luckily, there are many here in Ohio.
My insurance coverage channels me in the direction of the MD initialed these days. Most of my specailists are of that schooling but I've hung onto my DO family practice docs and pay the slightly higher co-pay for the pleasure and priviledge.
We used to have an entire osteopathic hospital just 15 miles from home. Unfortunately, it's doors closed a few years back when an over-zealous woman attempted to convert the useful community facility into a center for cardiac surgery excellence. Very sad. Not much can compare with seeing an Amish buggy or two at the hitching post when you pull into a hospital outpatient parking lot. These days they are forced to rely on the conglomerate hospital's motorized transportation assistance. But I've gone far afield now and totally forget where I intended to be.
Mary
My insurance coverage channels me in the direction of the MD initialed these days. Most of my specailists are of that schooling but I've hung onto my DO family practice docs and pay the slightly higher co-pay for the pleasure and priviledge.
We used to have an entire osteopathic hospital just 15 miles from home. Unfortunately, it's doors closed a few years back when an over-zealous woman attempted to convert the useful community facility into a center for cardiac surgery excellence. Very sad. Not much can compare with seeing an Amish buggy or two at the hitching post when you pull into a hospital outpatient parking lot. These days they are forced to rely on the conglomerate hospital's motorized transportation assistance. But I've gone far afield now and totally forget where I intended to be.
Mary
Ren,
This is very interesting reading here - thanks for starting this and thanks to Mary and Michelle for your contributions. I now have some new drugs to go and read about. I look forward to reading your updates, but even more I hope we will hear that you continue to improve with this treatment. -L
This is very interesting reading here - thanks for starting this and thanks to Mary and Michelle for your contributions. I now have some new drugs to go and read about. I look forward to reading your updates, but even more I hope we will hear that you continue to improve with this treatment. -L
Michelle,
I wasn't given a guarantee and was told the effects differ greatly between patients., I asked the average time of relief per procedure and he said 12-14 hours..some longer, some shorter. My actual total time being pain free was about 10 hours, but I'll take it.
Today I have a sore throat brewing and feel like c*ap and of course the pain is back but I also have the fatigue accompanying a relapse so at least I have slept 18-20 of the last 24 hours.
Mary,
I forgot to answer some of your previous questions. Re insurance, I assume it is covered as we had to waited for insurance approval before he would begin because in his words " you don't want to pay for this out of pocket", I'm assuming it's expensive..but what isn't if it's MS related?
My pain doc is a DO and if he follows his training , he should approach this from a holistic point of view. But, as I said before, my DH and I were taken aback with the deluge of information in such a short amount of time...reminiscent of a used car sales man, lol
In fact, I woke up to make BLT's for dinner and am heading back to bed after being up only an hour and a half. I will keep you updated as the weeks go by and tell you about the success of my procedures. What I find weird and want to research is a statement the doc made about the ketamine"resetting the" nervous system and bring it down a notch to lessen the pain.
Back to bed with a raging "migraine' or whatever it is and bilateral face pain.
Thanks ladies!
I'll update with my weekly results for the next 6 weeks...
Ren
I wasn't given a guarantee and was told the effects differ greatly between patients., I asked the average time of relief per procedure and he said 12-14 hours..some longer, some shorter. My actual total time being pain free was about 10 hours, but I'll take it.
Today I have a sore throat brewing and feel like c*ap and of course the pain is back but I also have the fatigue accompanying a relapse so at least I have slept 18-20 of the last 24 hours.
Mary,
I forgot to answer some of your previous questions. Re insurance, I assume it is covered as we had to waited for insurance approval before he would begin because in his words " you don't want to pay for this out of pocket", I'm assuming it's expensive..but what isn't if it's MS related?
My pain doc is a DO and if he follows his training , he should approach this from a holistic point of view. But, as I said before, my DH and I were taken aback with the deluge of information in such a short amount of time...reminiscent of a used car sales man, lol
In fact, I woke up to make BLT's for dinner and am heading back to bed after being up only an hour and a half. I will keep you updated as the weeks go by and tell you about the success of my procedures. What I find weird and want to research is a statement the doc made about the ketamine"resetting the" nervous system and bring it down a notch to lessen the pain.
Back to bed with a raging "migraine' or whatever it is and bilateral face pain.
Thanks ladies!
I'll update with my weekly results for the next 6 weeks...
Ren
Ren, and Mary,
Thanks SO much for sharing your experience and thinking of me.
Actually I did see a pain doc, before this new pain neuro, about 6 months ago. He recommended exactly this procedure, but explained it much differently. He told me it is a 50?50 chance that it will work, and then if it does, they go back and deaden the nerve.
I know it was different because he couldn't do it at the time because I was on Coumadin. I know his involved sticking a needle from the outside of my face very far, into the trigeminal nerve. I still have the brochure he gave me somewhere, I will have to go find it. Very interesting...
My new Pain neuro said it wouldn't work for me, because I have 4 cranial nerves involved, and it "might" help a bit, but wont get to the source of the problem.
From reading his letter to my MS neuro, the only thing he suggested if ALL else fails was something I don't understand and haven't looked it up, because I really don't want to know. (Ignorance is bliss sometimes)
It was Neuromodulatory surgery for evaluation of a central stimulator to stop the MS progression, if possible.
Anyway, I am so glad it has worked for you Ren, I am thrilled for you and hope it continues to help!
Hugs,
Michelle
Thanks SO much for sharing your experience and thinking of me.
Actually I did see a pain doc, before this new pain neuro, about 6 months ago. He recommended exactly this procedure, but explained it much differently. He told me it is a 50?50 chance that it will work, and then if it does, they go back and deaden the nerve.
I know it was different because he couldn't do it at the time because I was on Coumadin. I know his involved sticking a needle from the outside of my face very far, into the trigeminal nerve. I still have the brochure he gave me somewhere, I will have to go find it. Very interesting...
My new Pain neuro said it wouldn't work for me, because I have 4 cranial nerves involved, and it "might" help a bit, but wont get to the source of the problem.
From reading his letter to my MS neuro, the only thing he suggested if ALL else fails was something I don't understand and haven't looked it up, because I really don't want to know. (Ignorance is bliss sometimes)
It was Neuromodulatory surgery for evaluation of a central stimulator to stop the MS progression, if possible.
Anyway, I am so glad it has worked for you Ren, I am thrilled for you and hope it continues to help!
Hugs,
Michelle
Mary,
Actually, his technique differed slightly from the descriptions I found online. A 6 inch lidocaine impregnated q-tip was placed in each nostril and after a few minutes to take effect, he injected the cotton tip with Marcaine. This was probably the most uncomfortable feeling because my throat was numb from the lidocaine but I still felt the need to swallow as the Marcaine ran down my throat, and felt that I couldn't. The doc looked and assured me I was "not drowning". The feeling did pass rather quickly.
As the Marcaine started working I experienced a brief spell of dizziness, identical to my migraine vertigo so I'm not sure of the source of that sensation. It passed quickly. The q-tips were left in place 15-20 minutes. Pain scale when I arrived was 7 and 3 when I had just completed the treatment. After spending 20 minutes lining up 6 more follow-up appts. , the pain level was 0!
I'll have to check out the You Tube video, thanks for the tip!
Ren
Actually, his technique differed slightly from the descriptions I found online. A 6 inch lidocaine impregnated q-tip was placed in each nostril and after a few minutes to take effect, he injected the cotton tip with Marcaine. This was probably the most uncomfortable feeling because my throat was numb from the lidocaine but I still felt the need to swallow as the Marcaine ran down my throat, and felt that I couldn't. The doc looked and assured me I was "not drowning". The feeling did pass rather quickly.
As the Marcaine started working I experienced a brief spell of dizziness, identical to my migraine vertigo so I'm not sure of the source of that sensation. It passed quickly. The q-tips were left in place 15-20 minutes. Pain scale when I arrived was 7 and 3 when I had just completed the treatment. After spending 20 minutes lining up 6 more follow-up appts. , the pain level was 0!
I'll have to check out the You Tube video, thanks for the tip!
Ren
Mary,
Thanks for the link. I did find this in research as well as Dr. Sluder's work (excerpts),
Yes, I immediately thought of Michelle when this was explained and even more so when I read that article.
Of course, my kids said they want to watch mom "get high" on the ketamine. That part I'm not looking forward to but the doc promised Valium to decrease the "dissociated feeling" that accompanies the the ketamine.
Again, thanks and if you find anything new ,please let me know.
Ren
Thanks for the link. I did find this in research as well as Dr. Sluder's work (excerpts),
Yes, I immediately thought of Michelle when this was explained and even more so when I read that article.
Of course, my kids said they want to watch mom "get high" on the ketamine. That part I'm not looking forward to but the doc promised Valium to decrease the "dissociated feeling" that accompanies the the ketamine.
Again, thanks and if you find anything new ,please let me know.
Ren
Ren, was this an injection or did he place cotton tipped applicators in the area? What is the doc's definition of success for the initial three treatments? Must you have all three before he moves on to the ketamine? How does that procedure differ? Is this a costly treatment? Covered by insurance I assume? As always, only if you know these answers or care to share.
I come from the skeptic arena too but have become more of a believer since supplements and non-traditional treatment have helped me greatly the last few years. Pain management physicians have quite a bag of tricks to use if you can get in to see them and convince them you are more interested in relief than drugs.
There is a video on You Tube that shows a woman getting a Spenopalatine block treatment. Besides her stated pain relief, her face and body language say her energy level improved significantly, as you reported.
Mary
I come from the skeptic arena too but have become more of a believer since supplements and non-traditional treatment have helped me greatly the last few years. Pain management physicians have quite a bag of tricks to use if you can get in to see them and convince them you are more interested in relief than drugs.
There is a video on You Tube that shows a woman getting a Spenopalatine block treatment. Besides her stated pain relief, her face and body language say her energy level improved significantly, as you reported.
Mary
Wow Ren, I hadn't heard of it but I'm certainly glad I have now!! I'm going to ask the woman who does my massage and energy work about this but I can't reach her today. Her training is informal but she knows all about the energy and nerve centers in the body (mine, our horses, our dog....). She worked wonders in reducing my pain and getting me functional before my MS was diagnosed -- you know, during that time when the doctors cared but couldn't do more than test and head scratch and apologize. I know she wouldn't be able to perform this type of service but I'd love to hear what she has to say about it.
Your explanation from the pain management doc reminded me of eastern medicine and accupuncture principle. If nothing else because of how one point is connected to many others instead of standing alone. So I tried to do a little search. I did come up with a few sources in the orient. The link I'm going to post mentions that this procedure was known and written about in the 1930's (as the eastern medicine guys said too). It is mentioned as easy and effective but under-utilized. Imagine that!!
I'm sure many here will be interested to see how this process goes for you and if you can get some lasting relief. How wonderful this might be for MICHELLERIC!! I hope she sees it and asks her pain neuro. Wonder why he wouldn't mention it if he knows of it. So much better than narcotics!!
Do you suppose this is why kids so enjoy shoving misc stuff up their noses????
Thanks so much for sharing. Let us know what he says about the return of your pain and what you can expect down the line. I don't need this myself at the moment but I sure am going to be investigating the availability in our area come Monday.
Mary
Your explanation from the pain management doc reminded me of eastern medicine and accupuncture principle. If nothing else because of how one point is connected to many others instead of standing alone. So I tried to do a little search. I did come up with a few sources in the orient. The link I'm going to post mentions that this procedure was known and written about in the 1930's (as the eastern medicine guys said too). It is mentioned as easy and effective but under-utilized. Imagine that!!
I'm sure many here will be interested to see how this process goes for you and if you can get some lasting relief. How wonderful this might be for MICHELLERIC!! I hope she sees it and asks her pain neuro. Wonder why he wouldn't mention it if he knows of it. So much better than narcotics!!
Do you suppose this is why kids so enjoy shoving misc stuff up their noses????
Thanks so much for sharing. Let us know what he says about the return of your pain and what you can expect down the line. I don't need this myself at the moment but I sure am going to be investigating the availability in our area come Monday.
Mary
Have an Answer?
You are reading content posted in the Multiple Sclerosis Community
Top Neurology Answerers
Australia
ON
Queensland, Australia
Queen Creek, AZ
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease
