Nerve Block Therapy in Chronic Pain Management

  • Winston C. V. Parris
Part of the Current Management of Pain book series (CUMP, volume 9)


Chronic pain management continues to be a major challenge for the medical profession, and whereas about two decades ago the problem was not adequately addressed, it is gratifying to note that this challenge and its implications is increasingly recognized by almost all segments of the health delivery team. This fact is borne out by the large number of pain centers and pain clinics that have developed nationwide, and this number continues to increase yearly [1]. Unfortunately, the increase in the number of pain facilities has not corresponded with the increase in the quality of chronic pain management. Moreover, the “conquest” of pain is elusive and is still very far from satisfactory resolution. The good news is that tremendous direct and indirect progress is being made at several levels during the process of solving this major scourge of humankind. Testimony of this progress is borne out by the impressive list of pain-oriented scientific papers that continue to be delivered at international, national, and local pain meetings, and also at several medical specialty meetings (notably anesthesiology, neurosurgery, rehabilitation medicine, orthopedic surgery, psychology, and neurology). Nerve blocks have always formed an important part of perioperative pain management and are also a major modality in chronic pain management. At the recently concluded 6th World Congress of Pain held in Adelaide, Australia, an entire plenary session was allocated to postoperative pain.


Nerve Block Chronic Pain Patient Reflex Sympathetic Dystrophy Stellate Ganglion Epidural Blood Patch 
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  1. 1.
    Brena SF, Chapman SL (eds). 1985. Chronic Pain: Management Principles. Clinics in Anaesthesiology. Philadelphia, W.B. Saunders, pp. 1–16.Google Scholar
  2. 2.
    Woolf CJ. 1983. Evidence for a central component of post-injury pain hypersensitivity. Nature 306:686–688.PubMedCrossRefGoogle Scholar
  3. 3.
    Kehlet H. 1989. Surgical stress: The role of pain and analgesia. Br J Anaesth 63:189–195.PubMedCrossRefGoogle Scholar
  4. 4.
    Handwerker HO. 1990. Pain and inflammation. Pain 5:S217.CrossRefGoogle Scholar
  5. 5.
    Cousins MJ, Mather LE (editorial). 1989. Relief of postoperative pain: Advances awaiting application. Med J Aust 150:354–355.PubMedGoogle Scholar
  6. 6.
    Kehlet H. 1988. The stress response to surgery: Release mechanisms and the modifying effect of pain relief. Acta Chir Scand Suppl 550:22–28.Google Scholar
  7. 7.
    Riese W, Arrington GE Jr. 1963. The history of Johannes Mü ller’ s doctrine of the specific energies of the senses: Original and later versions. Bull Hist Med 37:179–183.PubMedGoogle Scholar
  8. 8.
    Dallenbach KM. 1939. Pain: History and present status. Am J Psychol 52:331.CrossRefGoogle Scholar
  9. 9.
    Rynd F. 1845. Introduction of fluid to the nerve. Dublin Med Press 13:167.Google Scholar
  10. 10.
    Pravaz CG. 1853. Sur un nouveau moyen d’ opérer la coagulation du sang dans les artères, applicable à la guérison des anéurismes. CR Acad Sci (Paris) 36:88.Google Scholar
  11. 11.
    Bier A. 1899. Versuche ü ber cocainisirung des riickenmarkes. Dtsch Z Chir 51:361.CrossRefGoogle Scholar
  12. 12.
    Standards for cardiopulmonary resusitation (CPR) and emergency cardiac care (ECC) JAMA 227 (Suppl.):883.Google Scholar
  13. 13.
    Ritchie JM, Ritchie B, Greengard P. 1965. The active structure of local anesthetics. J Pharmacol Exp Ther 150:152.PubMedGoogle Scholar
  14. 14.
    Albright GA. 1979. Cardiac arrest following regional anesthesia with etidocaine or bupiva-caine. Anesthesiology 51:285.PubMedCrossRefGoogle Scholar
  15. 15.
    Ravindran RS, Bond VK, Tasch MD, Gupta CD, et al. 1980. Prolonged neural blockade following regional analgesia with 2-chloroprocaine. Anesth Analg 58:447.Google Scholar
  16. 16.
    Lund PC, Cwik JC. 1965. Propitocaine (Citanest) and methemoglobinemia. Anesthesiology 26:569–571.PubMedCrossRefGoogle Scholar
  17. 17.
    Brown FW. 1977. Management of diskogenic pain using epidural and intrathecal steroids. Clin Orthop 129:72.PubMedGoogle Scholar
  18. 18.
    Burn JMB, Langdon L. 1970. Lumbar epidural injection for the treatment of chronic sciatica. Rheumatol Phys Med 10:368.PubMedCrossRefGoogle Scholar
  19. 19.
    Duncan GE, Strumpf WE. 1984. Target neurons for 3H-corticosterone in the rat spinal cord. Brain Res 307:321–326.PubMedCrossRefGoogle Scholar
  20. 20.
    Green LN. 1975. Dexamethasone in the management of symptoms due to hemiated lumbar disc. J Neurol Neurosurg Psychiatry 38:1211.PubMedCrossRefGoogle Scholar
  21. 21.
    Wilson F. 1981. Neurolytic and other locally acting drugs in the management of pain. Pharmacol Ther 12:599.PubMedCrossRefGoogle Scholar
  22. 22.
    Woolsey RM, Taylor JJ, Nagel HH. 1972. Acute effects of topical ethyl alcohol on the sciatic nerve of the mouse. Arch Phys Med Rehabil 53:410.PubMedGoogle Scholar
  23. 23.
    Wood KM. 1978. The use of phenol as a neurolytic agent: A review. Pain 5:205.PubMedCrossRefGoogle Scholar
  24. 24.
    Bengon HT, Chomka CM, Brenner EA. 1980. Treatment of reflex sympathetic dystrophy with regional intravenous reserpine. Anesth Analg 59:500–502.Google Scholar
  25. 25.
    Parris WCV, Misculis KE, Kambam JR, Franks JJ, Dettbarn WD. 1987. Verapamil potentiates bupivacaine-induced neural conduction blockade. Anesth 67(3A):A252.Google Scholar
  26. 26.
    Parris WCV, Nyhuis G, Dirksen R. Unpublished data.Google Scholar
  27. 27.
    Wang JK, Nauss LA, Thomas JE. 1979. Pain relief by intrathecally applied morphine in man. Anesthesiology 50:149–151.PubMedCrossRefGoogle Scholar
  28. 28.
    Covino BG, Bush DF. 1975. Clinical evaluation of local anesthetic agents. Br J Anaesth 47:289.PubMedGoogle Scholar
  29. 29.
    Blair MR. 1975. Cardiovascular pharmacology of local anaesthetics. Br J Anaesth 47:247.PubMedGoogle Scholar
  30. 30.
    Aldrete JA, Johnson DA. 1970. Evaluation of intracutaneous testing for investigation of allergy to local anesthetic agents. Anesth Analg 49:173.PubMedGoogle Scholar
  31. 31.
    Parris WCV, Dettbarn WD. 1988. Muscle atrophy following bupivacaine trigger point injection. Anesthesiol Rev 16(3):50–53.Google Scholar
  32. 32.
    Woolf CJ. 1983. Evidence for central component of postinjury pain hypersensitivity. Nature 306:686–688.PubMedCrossRefGoogle Scholar
  33. 33.
    Wall PD. 1988. The prevention of postoperative pain. Pain 33:289–290.PubMedCrossRefGoogle Scholar
  34. 34.
    Kehlet H. 1984. The stress response to anaesthesia and surgery: Release mechanisms and modifying factors. Clin Anaesth 2:315.Google Scholar
  35. 35.
    Cousins MJ. 1989. Acute and postoperative pain. In PD Wall, R Melzack (eds), Textbook of Pain, 2nd ed. Churchill Livingstone, New York, pp. 284–305.Google Scholar
  36. 36.
    Bryce-Smith R. 1951. Injection of the lumbar sympathetic chain. Anaesthesia 6:150.PubMedCrossRefGoogle Scholar
  37. 37.
    Bonica JJ. 1953. The Management of Pain. Philadelphia, Lea & Febiger.Google Scholar
  38. 38.
    Levine J, Baubaum A. 1987. The peripheral nervous system and the inflamatory process. Pain Suppl 4:S109.CrossRefGoogle Scholar
  39. 39.
    Zimmerman M. 1979. Neurophysiology of nociception. Pain and pain therapy. In JJ Bonica, V Ventafridda (eds), Advances in Pain Research and Therapy. New York, Raven Press.Google Scholar
  40. 40.
    Boas RA. 1978. Sympathetic block in clinical practice. Int Anesthesiol Clin 16(4).Google Scholar
  41. 41.
    Bonica JJ. 1959. Clinical Applications of Diagnostic and Therapeutic Nerve Blocks. Springfield, IL, Charles C. Thomas.Google Scholar
  42. 42.
    Linson MA, Leffert R, Todd DP. 1983. The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade. J Hand Surg 8:153.Google Scholar
  43. 43.
    Mayne GE, Brown M, Arnold P, Moya F. 1986. Pain of herpes zoster and postherpetic neuralgia. In PP Raj (ed), Practical Management of Pain, Chicago, Year Book Medical Publishers, pp. 345–361.Google Scholar
  44. 44.
    Parris WCV, Jamison RN, Lin S, Kambam JR. 1988. The use of stellate ganglion blocks in treating unilateral migraine headaches. Regional Anesth 13(1S):78.Google Scholar
  45. 45.
    Yanagida H, Kemi C, Suwa K. 1976. The effects of stellate ganglion block on idiopathic prolongation of the Q-T internal with cardiac arrhythmia (the Romano-Ward syndrome). Anesth Analg 55:782–787.PubMedCrossRefGoogle Scholar
  46. 46.
    Parris WCV, Reddy B, White H. 1991. Stellate ganglion block in pediatric patients. Anesth Analg 67:993–995.Google Scholar
  47. 47.
    Kune GA, Cole R, Bell S. 1975. Observations on the relief of pancreatic pain. Med J Aust 2:789.PubMedGoogle Scholar
  48. 48.
    Parris WCV. 1985. Nerve block therapy. In SF Brena, SL Chapman (eds), Chronic Pain: Management Principles. Clinics in Anaesthesiology. Philadelphia, W.B. Saunders, pp. 93–109.Google Scholar
  49. 49.
    Moore DC. 1971. Regional Block, 9th ed. Springfield, IL, Charles C. Thomas.Google Scholar
  50. 50.
    Lievre JA, Bloch-Michel H, Attali P. 1957. L’ injection trans-sacree: Etude clinique et radio-logique. Bull Mem Soc Med Hôp Paris 73:1110–1118.PubMedGoogle Scholar
  51. 51.
    Wilson CB, Hoff JR. 1984. Clinical features and surgical treatment of cervical discogenic radiculopathy and myelopathy. In HK Genant (ed), Spine Update 1984. San Francisco, Radiology Research and Education Foundation, pp. 273–279.Google Scholar
  52. 52.
    Swerdlow M, Sayle-Creer W. 1970. The use of extradural injections in the relief of lumbo-sciatic pain. Anaesthesia 25:128.PubMedCrossRefGoogle Scholar
  53. 53.
    Dirksen R, Rutgers MJ, Coolen JM. 1987. Cervical epidural steroids can reflect sympathetic dystrophy. Anesthiology 66:71–73.CrossRefGoogle Scholar
  54. 54.
    Delaney TJ, Rowlingson JC, Carron H, et al. 1980. The effects of steroids on nerves and meninges. Anesth Analg 59:610–614.PubMedGoogle Scholar
  55. 55.
    Knight CL, Burnell JC. 1980. Systemic side-effects of extradural steroids. Anaesthesia 35:593.PubMedCrossRefGoogle Scholar
  56. 56.
    Raymond SA, Gissen AJ. 1986. Differential nerve block. In GR Strichartz (ed), Handbook of Experimental Pharmacology, Vol. 81, Local Anesthetics.New York, Springer-Verlag.Google Scholar
  57. 57.
    Gasser HS, Erlanger J. 1929. Role of fiber size in establishment of nerve block by pressure or cocaine. Am J Physiol 88:581–591.Google Scholar
  58. 58.
    BonicaJ J. 1953. The Management of Pain. Philadelphia, Lea & Febiger.Google Scholar
  59. 59.
    Hannington-Kiff JG. 1970. Intravenous regional sympathetic block with guanethidine. Lancet 1:1019–1020.Google Scholar
  60. 60.
    Bengon HT, Chomka CM, Brenner EA. 1980. Treatment of reflex sympathetic dystrophy with regional intravenous reserpine. Anesth Analg 59:500–502.Google Scholar
  61. 61.
    Yaksh TL, Reddy SVR. 1981. Studies in the primate on the analgetic effects associated with intrathecal actions of opiates, alpha-adrenergic agonists and baclofen. Anesthiology 54: 451–461.CrossRefGoogle Scholar
  62. 62.
    Fleetwood-Walker S, Mitchell R, Hope PJ, et al. 1985. An alpha2 receptor mediates the selective inhibition by noradrenaline of nociceptive responses of identified dorsal horn neurones. Brain Res 334:243–254.PubMedCrossRefGoogle Scholar
  63. 63.
    Ford SR, Forrest WH, Eltherington L. 1988. The treatment of reflex sympathetic dystrophy with intravenous regional bretylium. Anesthesiology 68:137–140.PubMedCrossRefGoogle Scholar
  64. 64.
    Parris WCV, Harris R, Lindsey K. 1987. Use of intravenous regional labetalol in treating resistant reflex sympathetic dystrophy. Pain 4(Suppl.):S206.CrossRefGoogle Scholar
  65. 65.
    Amer S. 1982. The role of nerve blocks in the treatment of cancer pain. Acta Anaesthesiol Scand 74(Suppl.):104.Google Scholar
  66. 66.
    Levin AB, Katz J, Benson RC, Jones AG. 1980. Treatment of pain of diffuse metastatic cancer by stereotactic chemical hypophysectomy: Long term results and observations on mechanism of action. Neurosurgery 6:258.PubMedCrossRefGoogle Scholar
  67. 67.
    Hanley MR. 1985. Substance P antagonists. In D Bousfield (ed), Neurotransmitters in Action. Elsevier, Amsterdam, pp. 170–172.Google Scholar
  68. 68.
    Kambam JR, Hammon JW, Parris WCV, Lupinetti MD. 1989. Intrapleural analgesia for post-thoracotomy pain and blood levels of bupivacaine following intrapleural injection. Can J Anaesth 36(2):106–109.PubMedCrossRefGoogle Scholar
  69. 69.
    Raj PP, Montgomery SJ, Nettles D, et al. 1973. Infraclavicular brachial plexus block: A new approach. Anesth Analg 52:897–904.PubMedCrossRefGoogle Scholar
  70. 70.
    Parris WCV. 1990. Suprascapular nerve block: A safer technique. Anesthesiology 72:580–581.PubMedCrossRefGoogle Scholar
  71. 71.
    Brena SF. 1985. Pain control facilities: Pattern of operation and problems of organization inthe USA. In SF Brena, SL Chapman (eds), Chronic Pain: Management Principles. Clinics in Anaesthesiology. Philadelphia, W.B. Saunders, pp. 183–195.Google Scholar
  72. 72.
    Eagle WW. 1942. Sphenopalatine ganglion neuralgia. Arch Otolaryngol 35:66–70.CrossRefGoogle Scholar
  73. 73.
    Moskowitz MA. 1984. The neurobiology of vascular head pain. Ann Neurol 16:157–168.PubMedCrossRefGoogle Scholar
  74. 74.
    Gormley JB. 1960. Treatment of post spinal headaches. Anesthesiology 21:565–566.Google Scholar
  75. 75.
    Di Giovanni AJ, Galbert MW, Wahle WM. 1972. Epidural injection of autologous blood for post lumbar headache. II. Additional clinical experiences and laboratory investigations. Anesth Analg 51:226–232.Google Scholar
  76. 76.
    Parris WCV. 1987. The use of epidural blood patch in treating chronic headache: Report of six cases. Can J Anaesth 34(4):403–406.PubMedCrossRefGoogle Scholar
  77. 77.
    Travell J. 1976. Myofascial trigger points: Clinical view. In JJ Bonica, DJ Albe-Fessard, (eds), Advances in Pain Research and Therapy, New York, Raven Press, pp. 919–926.Google Scholar
  78. 78.
    Cope RW. 1954. The Wooley and Roe case. Wooley and Roe vs. the ministry of health and others. Anaesthesia 9:249–270.PubMedCrossRefGoogle Scholar
  79. 79.
    Gasser HS, Erlanger J. 1929. Role of fiber size in establishment of nerve blocks by pressure or cocaine. AMJ Physiol 88:581–592.Google Scholar

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© Springer Science+Business Media New York 1991

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  • Winston C. V. Parris

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