I. What causes peripheral neuralgia? Peripheral neuropathy mainly manifests as numbness, pain and weakness.
A variety of causes can cause peripheral nerve pain, mainly including.
1, nerve compression, such as fluid around the nerve, masses, skeletal tendon ligament degenerative lesions, etc. can be stuck on the nerve. The pain of most patients with cervical spondylosis and lumbar spondylosis is caused by nerve root compression;
2, peripheral neuritis, such as intercostal neuritis caused by herpes virus infection, primary lateral femoral cutaneous neuritis, etc.;
3, metabolic diseases, such as peripheral neuropathy caused by diabetes mellitus;
4, various primary and secondary neuromuscular lesions, etc.
Which peripheral nerve pain is suitable for local nerve block or radiofrequency treatment?
The first two types of diseases, i.e. nerve entrapment and certain peripheral neuritis, are suitable for interventional treatments such as nerve block and/or radiofrequency. A nerve block is a drug injection around or at the site of a diseased nerve. Radiofrequency treatment of peripheral nerves is indicated for cases where drug blocks are not effective.
C. What is nerve block? What is the principle of this method to treat pain?
The injection of analgesic and anti-inflammatory drugs around the diseased nerve is called nerve block, which can provide rapid pain relief and eliminate the inflammatory response, and achieve long-term pain relief or even cure. Commonly used drugs include: local anesthetics, such as lidocaine and ropivacaine, which can provide rapid pain relief.
Glucocorticoids, such as dexamethasone and compound betamethasone, can eliminate nonspecific inflammation in and around the nerve, thus reducing irritation, relieving compression and treating pain. Nerve-nourishing drugs, such as vitamin B12, adenosylcobalamin, and nerve growth factor, can nourish and promote nerve repair. Most of the nerve block treatments require 2-4 injections.
Fourth, why can nerve radiofrequency treat pain?
Pulsed radiofrequency can produce warmth below 42℃ around the diseased nerve, and can adjust the membrane potential of peripheral nerve, regulate or block the nerve conduction, thus breaking the pathological reflex loop of pain and playing an effective analgesic effect. Pulsed radiofrequency treatment can also reduce the inflammatory response of soft tissues and reduce their stimulation of nerves. Pulsed radiofrequency regulates nerve function and does not damage nerves. Radiofrequency ablation, on the other hand, destroys nerves through high temperature (80°C) and is only used for intractable pain, especially pain caused by cancer. Most of the radiofrequency treatments are effective in one treatment.
V. What are the advantages of ultrasound-guided peripheral nerve block and radiofrequency treatment?
Ultrasound-guided block and radiofrequency have the advantages of accuracy, few side effects and definite efficacy.
Ultrasound can show most peripheral nerves, such as cervical nerve roots, brachial plexus nerve, ulnar nerve, radial nerve, median nerve, femoral nerve, saphenous nerve, sciatic nerve, etc. Although some nerves cannot be directly shown by ultrasound, ultrasound can precisely locate their anatomical sites and distribution levels, such as occipital nerve, trigeminal nerve, intercostal nerve, pubic nerve and thoracic and lumbar nerve roots. For example, the sympathetic nerves in the neck and the sympathetic nerves in the abdominal cavity.
Ultrasound can also show the blood vessels and organs surrounding the nerves. For certain peripheral nerves, the resolution of ultrasound is better than X-ray, CT, and even MRI.
Ultrasound can show the nerve, surrounding tissues and needles in real time, and accurately guide injection and interventional needles around the target nerve, not only for accurate localization, but also to avoid damage to blood vessels and organs. Due to the accurate localization of ultrasound, treatment can be achieved with a smaller dose of drug and radiofrequency energy. Another advantage of ultrasound is that there is no radioactivity, no contrast agent is needed, and no additional damage is caused to the patient; the low cost, easy operation, flexibility and speed of ultrasound is also one of its major advantages.
Sixth, what specific diseases are suitable for nerve block or radiofrequency treatment
Generally speaking, the following diseases are suitable for ultrasound-guided nerve block and radiofrequency treatment.
1, pain caused by cervical spondylosis and lumbar spondylosis. Patients with cervical and lumbar cone disease have disc herniation and foraminal stenosis on the one hand, and on the other hand, they mostly have chronic inflammation of the soft tissues around the nerve roots, thus aggravating the corresponding nerve root compression. Blocking or radiofrequency of the nerve roots in the neck or lumbar region can effectively relieve pain, and some patients can even have long-term relief, thus avoiding surgery.
2. Peripheral nerve entrapment. For example, facial pain caused by trigeminal nerve entrapment, head and neck pain caused by cervical nerve entrapment, upper limb and shoulder pain caused by brachial plexus nerve entrapment, hip and lower limb pain caused by sciatic nerve entrapment, lower abdominal wall, inguinal region and perineal region pain caused by lumbar plexus nerve entrapment.
3.Pain related to vegetative nerve and its accompanying symptoms. For example, cervical sympathetic nerve block and radiofrequency can treat certain intractable headache, dizziness or tinnitus; visceral sympathetic nerve block or destruction can treat intractable pain caused by malignant tumors in the upper abdomen, such as the pain of pancreatic cancer. Lumbar sympathetic nerve block or destruction can treat pain caused by pelvic malignant tumors, ischemic pain of lower limbs caused by vascular spasm occlusion.
4.Neuritis. Such as pain caused by herpes zoster, atopic lateral femoral dermatomal neuritis, etc.
5.Pain caused by degenerative joint tendon lesions. Such as frozen shoulder, knee osteoarthritis in the elderly, plantar heel fasciitis, etc.