Tuesday, December 29, 2015

Facial Pain Relief in Chicago: Expertise in Trigeminal Nervous System is needed for Effective Treatment of Facial Pain, Migraine and Chronic Daily Headaches

Chronic facial pain is often seen in a very different light than other chronic pains.  For a long time Atypical Facial Pain was considered a psychiatric diagnosis   It is been reclassified and is now considered a trigeminal nerve or other cranial nerve disorder.

This type of pain is frequently associated with long term suffering and frequent misdiagnosis.  I have been treating chronic atypical facial pain for over 30 years in my Gurnee and Highland Park offices.
To learn more visit my office websites;
Highland Park:  www.ThinkBetterLife.com
Gurnee:   www.DelanyDentalCare.com

The ICD 10 coding for atypical facial pain or persistent idiopathic facial pain is as follows.
13.18.4Persistent idiopathic facial pain [G50.1]G44.847  
Previously used termsAtypical facial pain

THE DESCRIPTION OF THIS PAIN IS VERY SIMPLE AND COULD EASILY BE A MYOFASCIAL OR TMD CONDITION.  IT IS CONSIDERED DIFFERENT THAN HEADACHES OR MIGRAINES

Description:

Persistent facial pain that does not have the characteristics of the cranial neuralgias described above and is not attributed to another disorder.

Diagnostic criteria:

  1. Pain in the face, present daily and persisting for all or most of the day, fulfilling criteria B and C
  2. Pain is confined at onset to a limited area on one side of the face1, and is deep and poorly localised
  3. Pain is not associated with sensory loss or other physical signs
  4. Investigations including x-ray of face and jaws do not demonstrate any relevant abnormalit

POSSIBLY THE BEST METHOD OF CLASSIFYING THESE PAINS MAY NOT BE THE DESCRIPTION OF THE PAIN BUT RATHER WHAT THE PAIN RESPONDS TO.


SPB Blocks have been used for years to treat headaches, migraines and other pain disorders.  Sluders neuralgia was origiinally described in 1908 but is sometimes considered the original TMJ diagnos prior to the diagnosis of Costen's syndrome.  

The diagnosis of contact point headaches also known as Anterior Ethmoid neuralgia, pterygopalatine ganglion neuralgia, Sluder's Neuralgia and sphenopalatine Ganglion neuralgia often presents as pain of unknown orgin .  It can respond to SPG Blocks but in general is very resistant to diagnosis.

This condition may be a nerve compression syndrome but it can spread pain anywhere in the opthalmic or maxillary divisions or the Trigeminal Nerve.

The pain follows a similar pattern as trigger points in pterygoid, masseter and temporalis muscles.  It can sometimes be relieved by decongestants such as Afrin that shrink the nasal tissues.

Neuromuscular Dentistry in conjunction with SPG Blocks, Trigger Point injections, Spray and Stretch, prolotherapy is still the most effective approach to chronic facial pain.

All work should begin with reversible therapy and permanent changes should only be done after extended relief of pain.

#ChicagoMigraines, #ChicagoContactHeadache, #ChicagoSPGBlock, #ChgicagoImprovingQualityof Life, #IllinoisFacialPain

Monday, December 21, 2015

Chronic Daily Headaches, Migraines, Cluster Headaches & Rebound Headaches . SPG Blocks Spell Relief and Prevention

Originally posted as a Blog on www.ThinkBetterLife.com
The SPG Block or Sphenopalatine Ganglion Block can be extremely effective at preventing and eliminating migraines. The Sphenopalatine Ganglion is part of the Autonomic Nervous System. It is the Largest Parasympathetic Ganglion and treatment with lidocaine has been shown to be very effective for treating a wide variety of chronic and acute pain syndromes including Migraine, Cluster Headache, Chronic Daily Headache, New Persistent headache, Rebound Headache, Sinus Pain, Trigeminal Neuralgia, Autonomic Cephalgias and many other disorders.  It is frequently used for medically refractory headaches where all other treatments have failed.  SphenoPalatine Ganglion Blocks are probably grossly undrutilized based on safety and cost effectiveness.
There are multiple routes of administration including through the nose and by intra-oral or suprazygomatic injection.
There are several new FDA approved devices for delivering SPG blocks intranasally. These include the Sphenocath, the Allevio and the TX360. The MiRX protocol is specifically designed to prevent and eliminate migraines. The use of cotton tipped applicators saturated with lidocaine, cocaine or other anesthetic has been utilized for many years.
The use of hollow tipped applicators allow a continual feeding mechanism for anesthetic that can easily be accomplished by most patients. This method is extremely cost effective and convenient for patients.
Self administration of SPG Blocks is the key to putting chronic pain patients back in control of their lives.
The injection techniques are most effective in turning off an acute attack. I recently taught a hands on course to neuromuscular dentists at the ICCMO meeting in San Diego several methods of delivering anesthetic to the Sphenopalatine Ganglion.
Self administered Sphenopalatine blocks have been used for multiple conditions including CRPS, Complex Regional Pain Syndrome of the lower extremity (PubMed abstract below), Post Dural Puncture Headache, to treat Tension Headache in pregnant patients, and for OroFacial Pain (PubMed abstract below).  The usefulness has been described of SPG blocks in Pain clinics as well (PubMed Abstract below)

Arch Phys Med Rehabil. 2005 Feb;86(2):335-7.

Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option.

Abstract

We report 2 cases of complex regional pain syndrome (CRPS) involving the lower extremity; in both, a sphenopalatine ganglion (SPGblock was performed as part of a pain management program. In the first case, a woman in her late twenties presented with CRPS in the left lower extremity that was inadequately controlled with typical oral medications. Sympathetic block of the extremity did not provide significant pain relief. However, a noninvasive sphenopalatine block with 4% tetracaine resulted in a 50% reduction in pain level. The patient was shown how to self-administer the sphenopalatine block and was provided with exercises and therapy to help improve her functional status. The second case involved a woman in her mid forties with CRPS in the right lower extremity that was partially controlled with oral medications. The patient experienced a 50% reduction in pain level when SPG block with 4% tetracaine was given. Further study is needed to determine the effects of SPG blocks on symptoms related to chronic regional pain syndrome.
PMID:
15706564
[PubMed – indexed for MEDLINE]
Cranio. 1995 Jul;13(3):177-81.
Int J Obstet Anesth. 2014 Aug;23(3):292-3. doi: 10.1016/j.ijoa.2014.04.010. Epub 2014 May 10.

Transnasal topicalsphenopalatine ganglion block to treat tension headache in a pregnant patient.

Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain.

Abstract

The sphenopalatine ganglion (SPG) block is a safe, easy method for the control of acute or chronic pain in any pain management office. It takes only a few moments to implement, and the patient can be safely taught to effectively perform this pain control procedure at home with good expectations and results. Indications for the SPG blocks include pain of musculoskeletal origin, vascular origin and neurogenic origin. It has been used effectively in the management of temporomandibular joint (TMJ) pain, cluster headaches, tic douloureux, dysmenorrhea, trigeminal neuralgia, bronchospasm and chronic hiccup.
PMID:
8949858
[PubMed – indexed for MEDLINE]
Clin J Pain. 1990 Jun;6(2):131-6.
Am J Emerg Med. 2015 Nov;33(11):1714.e1-2. doi: 10.1016/j.ajem.2015.03.024. Epub 2015 Mar 14.

Transnasalsphenopalatine ganglion block for the treatment of postdural puncture headache in the ED.

Sphenopalatine ganglion block: clinical use in the pain management clinic.

Abstract

Clinical experience with the sphenopalatine ganglion (SPG) block combined with a review of prior studies led to conducting a retrospective evaluation of four patients with chronic pain treated with the SPG block. The review of case reports suggests the usefulness of SPG blocks in the pain management clinic.

Comment in

Headache. 2013 Jul-Aug;53(7):1183-90. doi: 10.1111/head.12148. Epub 2013 Jun 28.

Cluster headache: potential options for medically refractory patients (when all else fails).

Abstract

The most evidence exists for mixed anesthetic/steroid occipital nerve blocks (which are also useful in non-refractory patients), deep brain stimulation, sphenopalatine ganglion (SPG) blocks, SPG radiofrequency ablation, and SPG stimulation with the Autonomic Technologies, Inc (ATI) SPG Neurostimulator, the latter approved in the European Union and reimbursed in several countries.

Thursday, December 17, 2015

Self Administration of SPG Blocks by Patients. The Ultimate in Personal Medicine for Pain

This was originally published as a blog post on http://www.ThinkBetterLife.com.  There are multible testimonials on youtube about the effectiveness of sphenopalatine ganglion blocks.  https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg


The SPG Block or Sphenopalatine Ganglion Block can be extremely effective at preventing and eliminating migraines. The Sphenopalatine Ganglion is part of the Autonomic Nervous System. It is the Largest Parasympathetic Ganglion and treatment with lidocaine has been shown to be very effective for treating a wide variety of chronic and acute pain syndromes including Migraine, Cluster Headache, Chronic Daily Headache, New Persistent headache, Rebound Headache, Sinus Pain, Trigeminal Neuralgia, Autonomic Cephalgias and many other disorders.  It is frequently used for medically refractory headaches where all other treatments have failed.  SphenoPalatine Ganglion Blocks are probably grossly undrutilized based on safety and cost effectiveness.
There are multiple routes of administration including through the nose and by intra-oral or suprazygomatic injection.
There are several new FDA approved devices for delivering SPG blocks intranasally. These include the Sphenocath, the Allevio and the TX360. The MiRX protocol is specifically designed to prevent and eliminate migraines. The use of cotton tipped applicators saturated with lidocaine, cocaine or other anesthetic has been utilized for many years.
The use of hollow tipped applicators allow a continual feeding mechanism for anesthetic that can easily be accomplished by most patients. This method is extremely cost effective and convenient for patients.
Self administration of SPG Blocks is the key to putting chronic pain patients back in control of their lives.
The injection techniques are most effective in turning off an acute attack. I recently taught a hands on course to neuromuscular dentists at the ICCMO meeting in San Diego several methods of delivering anesthetic to the Sphenopalatine Ganglion.
Self administered Sphenopalatine blocks have been used for multiple conditions including CRPS, Complex Regional Pain Syndrome of the lower extremity (PubMed abstract below), Post Dural Puncture Headache, to treat Tension Headache in pregnant patients, and for OroFacial Pain (PubMed abstract below).  The usefulness has been described of SPG blocks in Pain clinics as well (PubMed Abstract below)

Arch Phys Med Rehabil. 2005 Feb;86(2):335-7.

Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option.

Abstract

We report 2 cases of complex regional pain syndrome (CRPS) involving the lower extremity; in both, a sphenopalatine ganglion (SPGblock was performed as part of a pain management program. In the first case, a woman in her late twenties presented with CRPS in the left lower extremity that was inadequately controlled with typical oral medications. Sympathetic block of the extremity did not provide significant pain relief. However, a noninvasive sphenopalatine block with 4% tetracaine resulted in a 50% reduction in pain level. The patient was shown how to self-administer the sphenopalatine block and was provided with exercises and therapy to help improve her functional status. The second case involved a woman in her mid forties with CRPS in the right lower extremity that was partially controlled with oral medications. The patient experienced a 50% reduction in pain level when SPG block with 4% tetracaine was given. Further study is needed to determine the effects of SPG blocks on symptoms related to chronic regional pain syndrome.
PMID:
15706564
[PubMed - indexed for MEDLINE]
Cranio. 1995 Jul;13(3):177-81.
Int J Obstet Anesth. 2014 Aug;23(3):292-3. doi: 10.1016/j.ijoa.2014.04.010. Epub 2014 May 10.

Transnasal topical sphenopalatine ganglion block to treat tension headache in a pregnant patient.

 

Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain.

Abstract

The sphenopalatine ganglion (SPG) block is a safe, easy method for the control of acute or chronic pain in any pain management office. It takes only a few moments to implement, and the patient can be safely taught to effectively perform this pain control procedure at home with good expectations and results. Indications for the SPG blocks include pain of musculoskeletal origin, vascular origin and neurogenic origin. It has been used effectively in the management of temporomandibular joint (TMJ) pain, cluster headaches, tic douloureux, dysmenorrhea, trigeminal neuralgia, bronchospasm and chronic hiccup.
PMID:
8949858
[PubMed - indexed for MEDLINE]
Clin J Pain. 1990 Jun;6(2):131-6.
Am J Emerg Med. 2015 Nov;33(11):1714.e1-2. doi: 10.1016/j.ajem.2015.03.024. Epub 2015 Mar 14.

Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED.

Sphenopalatine ganglion block: clinical use in the pain management clinic.

Abstract

Clinical experience with the sphenopalatine ganglion (SPG) block combined with a review of prior studies led to conducting a retrospective evaluation of four patients with chronic pain treated with the SPG block. The review of case reports suggests the usefulness of SPG blocks in the pain management clinic.

Comment in

Headache. 2013 Jul-Aug;53(7):1183-90. doi: 10.1111/head.12148. Epub 2013 Jun 28.

Cluster headache: potential options for medically refractory patients (when all else fails).

Abstract

The most evidence exists for mixed anesthetic/steroid occipital nerve blocks (which are also useful in non-refractory patients), deep brain stimulation, sphenopalatine ganglion (SPG) blocks, SPG radiofrequency ablation, and SPG stimulation with the Autonomic Technologies, Inc (ATI) SPG Neurostimulator, the latter approved in the European Union and reimbursed in several countries.
© 2013 American Headache Society.

KEYWORDS:

LSD; cluster headache; neuromodulation; occipital nerve blocksphenopalatine ganglion stimulation; vagal nerve stimulation