Somato-somatic theory of referred pain elucidates observations of referred sensations during micropigmentation of nipple-areolar complex in a cohort study on patients undergoing pedicled latissimus dorsi flap breast reconstruction.

AIM: Micropigmentation of the nipple-areolar complex is the final aesthetic step in autologous breast reconstruction. The mechanism of referred pain observed in patients during micropigmentation after a non-neurotonized pedicled latissimus dorsi flap breast reconstruction is poorly understood. METHODS: Patients undergoing micropigmentation for nipple-areolar restoration at our breast unit were included in this study. Baseline sensitivity of both breasts was recorded using a questionnaire and non-invasive Semmes-Weinstein monofilament testing. Patients experiencing local and regional referred symptoms, while undergoing micropigmentation, were identified and their clinical data were collected and analysed. Three months postoperatively, the patients completed a questionnaire pertaining to their satisfaction and future analgesic preference. RESULTS: Thirty (17.8%) patients experienced referred sensations during micropigmentation. Their symptoms ranged from "ache" (6.7%), "discomfort" (13.3%) to "deep pain" (13.3%) and were either local and/or referred to ipsilateral axilla, upper limb and back. The majority were pleased with postoperative outcomes [shape (30, 100%), size (28, 93.3%), colour match (22, 73.3%)] and a small number were not satisfied with the shape (2, 6.7%,) position (1, 3.3%) and appearance of the tattoo (1, 3.3%). CONCLUSION: Micropigmentation is a safe procedure with good patient satisfaction and low rates of complications; however, patients may experience significant local or referred symptoms. This observation can be explained by the proposed "somato-somatic" theory of referred pain and ascertains the need for use of oral and/or local anaesthetic as well as improved counselling in these patients.

Effect of nerve root block guided by ultrasound on cervicogenic pain and its influence on immune function.

Cervicogenic pain is a common chronic disease that needs individualized treatment according to the place of pain. This study aimed to observe the effect of ultrasound-guided nerve root block in the treatment of cervicogenic pain and its influence on immune function. A total of 30 patients (group A) with cervical discogenic pain (CDP) were treated by selective cervical nerve root block and 30 patients (group B) with CDP were treated with cervical spinal block under the X-ray C-arm guidance. The two groups of patients were examined with regard to the analgesic effect by Numerical Rating Scale (NRS), and the changes in the preoperative and postoperative range of motion in the neck (ROM). In addition, weekly pain attacks and the duration of each attack were recorded. The content of CD3+, CD4+ and CD8+ in the peripheral blood T lymphocyte subsets in the two groups was evaluated by flow cytometry. The levels of these subsets were compared 24 h before treatment, 24 h after treatment, 3 days (d) after treatment and 7 d after treatment. At the time periods of 24 h, 3 d, and 7 d after treatment, the NRS of the two groups decreased significantly compared with before treatment (P less than 0.01). The changes of the ROM, the number of weekly pain attacks, the duration of each pain attack, and the stiffness of the head and neck were significantly lower in the two groups compared with those prior to the treatment (P less than 0.05). In group A and group B, the number of CD3+, CD4+ and CD8+ T cells 24 h and 3 d after treatment increased significantly compared with that noted before treatment (P less than 0.05). Seven days after treatment, the levels of CD3+, CD4+ and CD8+ T cells in the peripheral blood T lymphocytes of group A were significantly higher than those of group B (P less than 0.05). Selective cervical nerve root block under ultrasound is an effective method for the treatment of cervical discogenic pain. The effect is better than that of the X-ray C-arm-guided cervical block method. The mechanism of selective cervical nerve root block under ultrasound may be related to the regulation of the content of CD3+, CD4+, CD8+ T cells in the peripheral blood T lymphocyte subsets and the enhancement of cellular immunity.

Surgical outcomes for rhinogenic contact point headaches.

OBJECTIVE: To evaluate the surgical outcome in patients diagnosed as having rhinogenic contact point headaches (RCPH). SUBJECTS AND METHODS: Thirty-six patients (aged 17-58 years) with RCPH underwent mini functional endoscopic sinus surgery procedures. Patients' pain complaints were evaluated with a visual analog scale (VAS) both pre- and postoperatively. RESULTS: All patients reported a decrease in the intensity of pain postoperatively. Nineteen patients (52.7%) reported complete relief. The difference between the preoperative (mean 8.62) and postoperative VAS pain scores (mean 2.11) was statistically very significant (p = 0.0000). No major complications were encountered. CONCLUSION: The removal of contact points in patients with RCPH is very effective in carefully selected patients.

Interstitial Cystitis/Bladder Pain Syndrome as Referred Pain From Injured T12/L1 Nerves: Symptomatic Improvement With Resection of Ilioinguinal and Iliohypogastric Nerves.

OBJECTIVE: To evaluate the specific contribution of ilioinguinal (II) and iliohypogastric (IH) nerve injury and referred pain to interstitial cystitis/bladder pain syndrome and patient-reported chronic pelvic pain, and to enumerate the effects of II and IH nerve resection on the pain and voiding symptoms in patients with IC/BPS. MATERIALS AND METHODS: This was a prospective cohort study of 8 patients with ICS/BPS who had prior abdominal surgery. All patients received diagnostic image guided T12/L1 nerve blocks, followed by II and IH nerve resections. Validated O'Leary-Sant ICS symptom indices (OSPI) and pelvic pain and urgency/frequency patient symptoms scale (PUF) scores were collected at specified intervals pre- and post-operatively. RESULTS: Median scores at pre-operative (OSPI 13.9, PUF 20.4) and 1 week time points (OSPI 5.9, PUF 11), as well as differences between pre-operative and 10 month time points (OSPI 3.7, PUF 6) were all statistically significant (P = .008 and .009 at 1 week, and .007 and .008 at 10 months, for OSPI and PUF respectively). The mean difference in score from pre-operative to longest follow-up as measured by the OSPI was -14.4 (P < .001) and by PUF -10.3 (P < .001). All time points registered demonstrated improvement in pain scores. There were no surgical complications or adverse events. CONCLUSION: II and IH nerve resection may be an effective and durable treatment option for those with prior abdominal surgery who have referred interstitial cystitis/bladder pain syndrome pain from these injured nerves.

Radiofrequency Denervation of the Cervical and Lumbar Spine.

Facet or zygapophysial joint pain is commonly seen in the aging population. Interventional procedures, such as facet joint nerve blocks, facet intraarticular injections, and radiofrequency denervation, are used for the diagnosis and treatment of axial spinal chronic neck and low back pain. The focus of this article is to understand how radiofrequency denervation works in the cervical and lumbar spine and to be able to properly select appropriate patients who might benefit from this safe and effective procedure.