Chronic Pain (cont.)
Nerve blocks
Nerve blocks may involve local anesthesia, regional anesthesia
or analgesia, or surgery; dentists routinely use them for traditional dental
procedures. Nerve blocks can also be used to prevent or even diagnose pain.
In the case of a local nerve block, any one of a number of local anesthetics
may be used; the names of these compounds, such as lidocaine or Novocaine,
usually have an aine ending. Regional blocks affect a larger area of the body.
Nerve blocks may also take the form of what is commonly called an epidural, in
which a drug is administered into the space between the spine's protective
covering (the dura) and the spinal column. This procedure is most well known for
its use during childbirth. Morphine and methadone are opioid narcotics (such
drugs end in ine or one) that are sometimes used for regional analgesia and are
administered as an injection.
Neurolytic blocks employ injection of chemical agents such as alcohol,
phenol, or glycerol to block pain messages and are most often used to treat
cancer pain or to block pain in the cranial nerves. In
some cases, a drug called guanethidine is administered intravenously in order to
accomplish the block.
Surgical blocks are performed on cranial, peripheral, or sympathetic nerves.
They are most often done to relieve the pain of cancer and extreme facial pain,
such as that experienced with trigeminal neuralgia. There are several different
types of surgical nerve blocks and they are not without problems and
complications. Nerve blocks can cause muscle paralysis and, in many cases,
result in at least partial numbness. For that reason, the procedure should be
reserved for a select group of patients and should only be performed by skilled
surgeons. Types of surgical nerve blocks include:
- Neurectomy (including
peripheral neurectomy) in which a damaged peripheral nerve is destroyed.
- Spinal dorsal rhizotomy
in which the surgeon cuts the root or rootlets of one or more of the nerves
radiating from the spine. Other rhizotomy procedures include cranial rhizotomy
and trigeminal rhizotomy, performed as a treatment for extreme facial pain or
for the pain of cancer.
- Sympathectomy, also
called sympathetic blockade, in which a drug or an agent such as guanethidine
is used to eliminate pain in a specific area (a limb, for example). The
procedure is also done for cardiac pain, vascular disease pain, the pain of
reflex sympathetic dystrophy syndrome, and other conditions. The
term takes its name from the sympathetic nervous system and may involve, for example, cutting a nerve that controls contraction
of one or more arteries.
Source: The National Institute of Neurological
Disorders and Stroke, National Institutes of Health (http://www.ninds.nih.gov/).
Last Editorial Review: 4/26/2006
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