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Saturday, August 22, 2015

Why haven't I Heard of SPG Blocks Before?

The Sphenopalatine Ganglion Block has been used for while over a century.  So, why does it seem like nobody has ever heard of it until recently and why is it changing now.

According to an article in the Pain Practitioner in 2004, "Sphenopalatine Ganglion Blockade: A Review and Proposed Modification of the Transnasal Technique Report of Technique" by  Robert E. Windsor, MD, and Scott Jahnke, DO  the accepted uses of "the SPG block are sphenopalatine neuralgia, trigeminal neuralgia, atypical facial pain, acute migraine, acute and chronic cluster headaches, herpes zoster involving the ophthalmic nerve and a variety of other facial neuralgias. The mechanism by which intranasal lidocaine alleviates the pain is not fully understood, however it is believed to reverse the parasympathetic contribution to intracranial vasodilatation by blocking the sphenopalatine ganglion. It is not considered a first line treatment for low back pain, sciatica, arthritis, or angina despite several studies showing statistical benefit."

This article shows that there are a wide variety of accepted uses of the SPG Block.  The best selling book "Miracles on Park Avenue" basically described a doctor who utilized the SPG block on all comers for chronic pain with amazing results in problems like Fibromyalgia.  One problem  with the block was it used an aqueous solution of cocaine that is highly regulated by the DEA and only ENTs routinely used it in practice.

Sluder first used the term sphenopalatine neuralgia in 1909. He described unilateral facial pain associated with signs of parasympathetic hyperactivity such as mucosal congestion, rhinorrhea, and lacrimation. Many considered this the first description of TMJ disorders without the joint component.
TMJ Disorders are frequently referred to as "The Great Imposter" because they mimic so many other conditions.

 Precacci et al found lessening of trigger point pain following SPG blocks on patients suffering from complex regional pain syndrome. This effect on trigger points is without risk of side effects compared to new drugs treating Fibromyalgia such as Lyrica.  Fibromyalgia is not cured by SPG Blocks but symptoms are vastly improved.  The connection of Fibromyalgia to Sleep by Moldofsky firmly placed it as an autonomic nervous disorder.  The SPG Block is like a reset button for the sympathetic and parsympathetice components of the autonomic nervous system.

Boston University School of Medicine  utilized SPG blocks with topical application of 10% cocaine solution and found improvement in acute low back and musculoskeletal pain.  There was significant improvement compared to plcebo and patients also showed increases in mobility.

Cluster Headaches were shown to be aborted by Barre  in 1982( after the topical application of cocaine.  This was the first instance I found of patients being taught to apply the anesthetic at home.

Kittrelle et al showed in 1985 that lidocaine had equivlant effects to cocaine in aborting acute cluster headaches.

 Berger et al in 1986  used of 4% topical Xylocaine and found it equal  to 10% cocaine and better than placebo for the relief of pain in patients with chronic lower back pain.

The SPG Block is back after being utilized by only a small number of Dentists and Physicians for several years.  A small number of dentists became the became the defacto experts in utilizing this block.  I learned from Jack Haden in Kansas City initially but my friend Dr Barry Glassman and Larry Lockerman also increased my knowledge.  I became obsessed with the literature because my wife had frequent pain from endometriosis / Endomyosis and the SPG Block removed the issue of severe pain.  Later , after being diagnosed with stage four ovarian cancer we again found SPG Blocks to be helpful in controlling the pain. (not the disease)

In the last few years three companies have brought devices to market to simplify SPG Blocks.  The TX360, the Sphenocath and Allevio all work by targeting squirts of anesthetic over the area of nasal mucosa covering the Ganglion.

I prefer the continuous feed method obtained with a hollow swab continually delivering anaesthetic over a period of time.  My preference is based on it being highly effective, and as  Barre found  in 1982 patients could be taught to self administer treatment at home.  This method is also extremely ineffective drastically lowering costs to both insurance companies and to patients.

When a patient is in the middle of a severe Pain episode the intra-oral injection or facial injection is most effective and will give the fastest relief.

I currently teach courses to Physicians and Dentists on administration of SPG Blocks.  I also teach patients how to utilize this excellent treatment to improve their quality of life.  When patients are in a doctors office their quality of life is lessened, when they can use SPG Blocks to turn of their pain without disrupting their lives the truly have an excellent treatment.

To learn more about treatment with SPG Blocks contact me thru www.ThinkBetterLife.com.

I utilize SPG Blocks along with TENS, Diagnostic neuromuscular orthotics, neuromuscular dentistry, trigger point injections, transcranial neurotransmitter modulation, spray and stretch, NuCalm and other techniques to restore quality of life as rapidly as possible.

Patient Testimonials are available on the ICCMO website:
  http://occlusiontmjauthority.com/dr-ira-shapira-testimonials/   and at

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SPG Nerve Block catheter Bibliography CHRONIC DAILY HEADACHE AND MIGRAINE
 Agency of Healthcare Research and Quality, a division of the Department of Health & Human Services,
 “Over 3 Million Look to Hospitals for Headache Relief, Particularly for Migraines,”
 http://www.ahrq.gov/news/nn/nn050411.htm Archibald N, et al.
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Agency for Health Care Policy and Research (US); February 1999,
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 Epidemiology of Chronic Daily Head in the General Population, Headache, March 1999, 
http://www.ncbi.nlm.nih.gov/pubmed/15613213 CIA World Fact Book,
https://www.cia.gov/library/publications/the-worldfactbook/ fields/2002.html Coeytaux, RR, et al.
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Headache. 2007 Jan; 47(1): 7-12, http://www.ncbi.nlm.nih.gov/pubmed/17355488 Cohen, S, et al. 
A new interest in an old remedy for headache and backache for our obstetric patients: a sphenopalatine ganglion block. 
Anaesthesia, 2000, 56, 606- 07, http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2001.2094-34.x/full 
Evans, RW, Diagnostic Testing for Chronic Daily Headache, 
Current Pain and Headache Reports 2007, 11:47-52,

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