Pulsed radiofrequency to stellate ganglion for brachial plexus injury-induced complex regional pain syndrome: A case series.

Brachial plexus injury (BPI) occurs commonly in young adults following trauma. This may result in the development of complex regional pain syndrome (CRPS) following injury, which is difficult to treat. We present a group of patients with CRPS secondary to BPI. These patients were managed with neuromodulation of the stellate ganglion (SG) with pulsed radiofrequency (PRF) and followed up for a period of 3 months to assess for pain relief and a decrease in the intake of medications after the intervention. PRF to SG was found to have significant pain relief lasting around three months.

Efficacy of stellate ganglion interventions for complex regional pain syndrome in the upper limb-A systematic review and meta-analysis.

Background and Aims: Stellate ganglion (SG) interventions for treating upper limb complex regional pain syndrome (CRPS) have been reported in studies. However, more substantial evidence is required to reach a consensus on its analgesic efficacy. To the best of our knowledge, no systematic review demonstrating the effectiveness of SG intervention for upper limb CRPS has been reported. Hence, this meta-analysis was done to ascertain the efficacy of SG intervention in managing patients with upper limb CRPS. Methods: A database search of PubMed, Cochrane, Embase, Scopus and Google Scholar was done for articles published between January 2001 and December 2021. Two independent reviewers extracted data from the included studies, and the studies were evaluated for any potential risk of bias, and a meta-analysis was performed. Results: Eight studies were included in the qualitative synthesis, four were randomised controlled trials (RCTs), and the rest were non-RCTs. Six studies were assessed quantitatively. A significant reduction in pain scores post-intervention, up to two weeks, and four to 28 weeks after the procedure was observed, although the included studies exhibited marked heterogeneity. Qualitative analysis of these studies revealed an overall improvement in disability scores and functionality as assessed by an improved range of motion. Most studies reported no complications or only short-term minor complications after the procedure. Conclusion: Stellate ganglion interventions improve pain and disability scores with self-limiting short-term complications and no long-term complications. However, further studies with a large sample size are required to validate this treatment modality.

Effect of autologous platelet-rich plasma (PRP) on low back pain in patients with prolapsed intervertebral disc: A randomised controlled trial.

Background and Aims: Prolapsed intervertebral disc (IVDP) is a major cause of low back pain. Platelet-rich plasma (PRP) has emerged as a viable option for these patients, with fewer adverse effects and long-term sustainability of pain relief. This double-blinded, randomised study aimed to evaluate the effect of autologous PRP on low back pain in patients with IVDP. Methods: A total of 42 patients with IVDP were randomised either to the autologous PRP (n = 21) group or control (epidural local anaesthetics with steroids; n = 21) group. Change in pain was assessed using the Numeric Rating Scale (NRS). Impact of treatment was assessed using the Global Perceived Effect (GPE) scale. All the patients were followed up for six months. Data was compared using Chi-square, independent sample t, and Mann-Whitney U tests. Results: The two groups were similar in their demographic and clinical profile. The baseline mean NRS ± standard deviation (SD) was 6.91 ± 0.94 in the PRP group and 7.38 ± 1.16 in the control group (P = 0.099). At six months, the mean NRS ± SD was 1.43 ± 0.75 in the PRP group compared to 5.43 ± 0.75 in the control group (P < 0.001). The GPE score was also found to be significantly higher in the PRP group, compared to the control group in the final assessment (P < 0.001). During the course of the study, the PRP group showed a consistent decline in NRS, whereas the control group showed an initial decline followed by consistent increase in NRS. Conclusion: PRP provided sustained relief from low back pain due to IVDP and can be recommended as a safe and promising alternative to epidural local anaesthetics and steroids.

Stellate Ganglion Blocks for Refractory Central Poststroke Pain: A Case Series.

Central poststroke pain (CPSP) is a neuropathic pain secondary to cerebrovascular accidents. This is characterized by pain and other sensory abnormalities, which correspond with the area of the injured brain. Despite advancements in therapeutic options, this clinical entity is still challenging to treat. We present 5 patients with CPSP, who were refractory to pharmacotherapy and were successfully managed with stellate ganglion blocks. A significant decrease in pain scores and improvement in functional disabilities were noted in all patients following the intervention.

Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis.

Background and Aims: Neurolytic splanchnic nerve block (NSNB) is practised in intractable abdominal pain secondary to intra-abdominal malignancies. This review evaluated the efficacy of NSNB. Methods: PubMed, Embase, Scopus, and Cochrane databases were searched for articles published from January 2001 to October 2023. Two independent reviewers extracted the data from the included studies. The quality of randomised controlled trials (RCTs) was assessed using the revised Cochrane risk-of-bias tool (RoB 2), and the Newcastle-Ottawa scale was used for cohort studies. Results: Fourteen articles (4 RCTs, 3 non-randomised prospective, and 7 retrospectives) were included. Ten articles were quantitatively assessed and demonstrated significant pain relief at 1 week (standardised mean difference (SMD): 3.46 [2.09, 4.83], P < 0.001, I2 = 95%), 2 weeks (SMD: 4.45 [2.61, 6.29], P < 0.001, I2 = 95%), 4 weeks (SMD: 3.35 [2.23, 4.47], P < 0.001, I2 = 97%), 8 weeks (SMD: 3.7 [2.71, 4.7], P < 0.001, I2 = 86%), 12 weeks (SMD: 4.01 [2.66, 5.36], P < 0.001, I2 = 95%), and 24 weeks (SMD: 2.54 [1.71,3.37], P < 0.001, I2 = 84%). Daily narcotic consumption and quality of life (QOL) significantly improved post neurolysis, but survival rates showed controversial results. Significant heterogeneity was reported, and sub-group analysis revealed a moderate level of variability [I2 = 47.3%] pertaining to study design as a source of heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Pro GDT recommendation for the primary objective was 'high' for the analysis of RCTs and 'very low' evidence quality for observational studies. Only transient minor complications were reported. Conclusion: NSNB appears to be an efficacious technique that provides substantial pain relief, reduces opioid consumption, and ameliorates QOL.