Steroid question, dont know if any one can answer this, but thought I would ask.

[michelleric]

I just realized I might be in trouble with my appt tomorrow.  It is my 3 month F/U with my "Pain" neuro for another set of Sphelphalitine blocks in my head. (I completely know I misspelled that but I am not going to go back and find out the correct spelling, sorry.

I can only have these 3 injections every 3 months. They are a steroid with Lidocaine in the back of my R scapl, lower ear and lower neck.  It has been the ONLY thing that has helped with my debilitating  face/ear/scalp pain with this nasty disease.

I just finished my IVSM yesterday and started the taper today.  Does anyone know if I will have trouble getting the shots tomorrow due to my current steroid situation??  If it does, I will be extremely upset.

Just curious if any one know this.
Thanks,   Michelle

[COBOB]

No, I have not.  I'm well controlled at this point on less than $2.00 of Tegretol per month (with insurance coverage.)  I'm taking 200mg three times a day.  At this point, the Tegretol is costing me far less than the acupuncture would (and the Tegretol is covered.)

[Lulu54]

Michelle and I have already talked about this, but Bob - have you tried acupuncture for your TN?  It is recognized by the NIH as being an effective pain management for TN and lots of other things, too.  Just wondering...........

[COBOB]

I have TN that is controlled by Tegretol.  No occipital neuralgia (knock on wood.)  I looked it up in an anesthesia text I have here on regional blocks.  When I was in the Navy, general anesthesia can be rough to deal with at sea, so when we could, we used IV sedation and local or regional blocks.  Most of the time, we could sew up a scalp with local anesthesia.  Bug nasty jobs required moving to regional blocks.  

It is the same theory, but we were not doing it for long term pain management.  We did it to five us a couple of hours to put things back together.

Bob

[michelleric]

Just came from the Pain Neuro.  He gave me 5 blocks today.  Bob, the greater occipital block can radiate upwards and affect the trigeminal nerve as well.  He did the injections in quite a few different places.

Have you had this procedure done?  My doctor does/did explain things well, it is when I am in so much pain, I have a hard time concentrating on the details.  Just needing the pain to be gone.
Michelle

[COBOB]

Doctors are a bit strange in that they don't always explain stuff well.  The Sphenopalatine ganglion is up above the top of the turbinates in the nose at the base of the sphenoid sinus.  The sphenoid sinus is formed by the base of the brain and sphenoid bone.

Sphenopalatine blocks can be done with a needle up through the nose.  Injections to the left and right (one inch down and one inch lateral to the bony point on the occipital plate (the inion) are more correctly called occipital blocks.  

They are done together to break the pain cycle caused by Occipital Neuralgia (Cevical 2 Neuralgia).  This pain syndrome is very similar to Trigeminal Neuralgia (Cranial Nerve 5 Neuralgia.)

Bob

[michelleric]

I checked more into this.  Yes, it is 1 in the morning and yes, these steroids are making me an insomniac.  yes, I have taken a sleep med, but only lasts for about 2 hours.

Anyway, looks like I had an Occipital Nerve Block, in 3 locations.  Although neuro told me this can also take care of the trigeminal nerve pain ,as well the other 3 cranial nerves that are affected. (Hopefully anyway, no guarantees, but so far this has been the best pain relief I have had for years.)

At this point though, it looks like I have yet another 2 cranial nerves that are taking a beating as well. (Hence the double vision and my decreased hearing in my R ear as well.)

Michelle

[michelleric]

Bob,
My Sphenopalatine ganglion blocks are done externally.  The are injections given to the back of my scalp in 3 different places.  I am sure the location varies from person to person.

It is doing it from the "outside" rather than the "inside".  I think it is a bit more invasive, but the procedure you described and "one" in the same. (meaning they are "trying" to treat the same nerves).
Thanks,
Michelle

[COBOB]

By the way, the normal medication used in an occipital block is a mix of 40-80 mg of methylprednisolone and lidocaine or bupivicaine.  

Bob

[COBOB]

Sphenopalatine ganglion blocks are done with the cotton applicators up the nose.  I;m guessing they are also doing an occipital black at the same time.  They may choose to just use the local anesthetic without the steroid,   The steroid usually reduces any local inflammation associated with the injection.   Since it is a regional pain block, the steroid doesn't have a whole body (systemic) effect, so they may just do what they have done before.  There really is very little to the "art of medicine."  Most of medicine is "continuing to do stuff that has worked in the past."  

Don't worry about it.  Let them know you are tapering off IVSM, but I'll bet they continue to do the procedure as they have before.

Bob

[Lulu54]

Too bad you couldn't get the IV run through your head instead of your arm! LOL

I think you already know that you will have to call these folks in the morning and ask or at least go and discuss this in person with the doctor.  

good luck - I hope it will be ok for you.

hugs, L