Here we report on the use of neurolytic block of ganglion impar (ganglion of Walther) for the management of intractable chronic pelvic pain, which is common enough to be recognized as a problem by gynecologists, likely to be difficult to diagnose and even more challenging to manage. Following failure in controlling the symptoms with pharmacological management, nine women underwent neurolysis of the ganglion impar in our Pain Clinic from 2009 to March 2013. The indication for the procedure was chronic pelvic pain (CPP) of either malignancy-related (4) or other origin (5). The Numeric Rating Scale (NRS) and duration of pain relief were employed to assess effectiveness of the procedure. Neurolysis was efficacious in patients with both malignancy-related CPP and CPP of non-malignant origin. Reported relief time varied from 4 weeks to 3 years, while in 4 cases complete and permanent cessation of pain was achieved. No complications were noted.

It may be concluded that SNBs may still be considered useful in PHN management, as it appears that in some cases this mode of treatment may offer some advantages over 5% LMP.

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This study was performed to present the outcomes of trigeminal neuropathy management with the application of neurolytic block of sphenopalatine ganglion. This type of procedure is used in cases where pain is not well controlled with medical treatment. Twenty patients were treated with sphenopalatine ganglion neurolysis after their response to pharmacological management was not satisfactory. Significant pain relief was experienced by all but one patient and they were able to reduce or stop their pain medication. The time of pain relief was between a few months and 9 years during the study period. Number of procedures implemented varied as some of the patients have been under the care of our Pain Clinic for as long as 18 years, satisfied with this type of management and willing to have the procedure repeated if necessary. It appears that neurolytic block of sphenopalatine ganglion is effective enough and may be an option worth further consideration in battling the pain associated with trigeminal neuropathy.

Conventional radiofrequency (CRF) is an interventional chronic pain treatment method with the use of electromagnetic waves at the frequency of radio waves (or higher) consisting in a controlled use of high temperature in order to destroy sympathetic and/or sensory fibres. Application time equals 60s and the temperature achieved in the tissues, depending on the application site, 60-90ºC. Pulsed radiofrequency (PRF) constitutes another treatment method which also uses radio waves at high frequencies. It consists in implementing series of 20ms current injections at frequencies of 2 Hz with a specific voltage (2-45 V), which results in an increase of the temperature around the electrode up to 42-50ºC. According to the International Association for Study of Pain (IASP), an indication for the application of interventional methods is chronic pain resistant to pharmacological treatment, as well as non-invasive methods, with a positive response to a prognostic blockade. This article discusses both the mechanism of conventional and pulsed radiofrequency, its application in specific pain syndromes, the most common complications and its side effects. The efficacy and safety of CRF and PRF in the treatment of lumbosacral pain, pain in knee joints, occipital neuralgia, painful shoulder syndrome, neuralgia/trigeminal neuropathy, peripheral neuropathy, neuropathic pain of the sympathetic system and cancer pain was presented based on data from literature. It seems that the application of radiofrequency and its applicability in certain pain syndromes is well-documented (trigeminal neuralgia, Horton's headache, osteoarthritis of the interspinous joints), while further research is required to develop a methodology for the radiofrequency procedure of knee joints or occipital nerves, despite promising results. The possibility of using more and more precise imaging methods constitutes a significant factor in order to carry out the procedure in an effective and safe way (USG, computed tomography, laser techniques, 3D printing). Med Pract 2019; 13, 2: 70-75 Palliat

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