A 78-year-old male patient had chronic, unrelieved abdominal pain due to mesenteric ischaemia. Unsuccessful pharmacological approaches included oral morphine plus coadjuvants as well as a sympathetic celiac plexus block which gave pain relief that lasted for 72 h. In order to obtain long-lasting relief, a trial epidural stimulating electrode was implanted after obtaining informed consent and Ethical Committee approval. Complete analgesia was achieved during a trial period of 2 weeks. Thereafter, a spinal cord stimulator was implanted. At the time of writing, 11 months after implantation, the degree of analgesia is complete. We believe that spinal cord stimulation may represent an alternative approach in controlling pain due to mesenteric ischaemia.

Lumbar sympathetic blocks (LSBs) are commonly performed to treat pain ailments in the lower limbs. LSBs involve injecting local anesthetic around the nerves. The injection is guided by fluoroscopy which is sometimes considered to be insufficiently accurate. The main aim was to analyze the plantar foot skin temperature data acquired while performing LSBs in patients with complex regional pain syndrome (CRPS) affecting the lower limbs. Forty-four LSBs for treating lower limb CRPS in 13 patients were assessed. Pain medicine physicians visualized the infrared thermography (IRT) video in real time and classified the performance depending on the observed thermal changes within the first 4 min. Thirty-two percent of the cases did not register temperature variations after lidocaine was injected, requiring the needle to be relocated. Differences between moments are indicated using the 95% confidence intervals of the differences (CI 95%), the Cohen effect size (ES) and the significance (p value). In successful cases, after injecting lidocaine, increases at minute 7 for the mean (CI 95% (1.4, 2.1 °C), p < 0.001 and ES = 0.5), at minute 5 for maximum temperature (CI 95% (2.3, 3.3 °C), p < 0.001 and ES = 0.6) and at minute 6 for SD (CI 95% (0.2, 0.3 °C), p < 0.001 and ES = 0.5) were observed. The results of our preliminary study showed that the measurement of skin temperature in real time by infrared thermography is valuable for assessing the success of lumbar sympathetic blocks.

Preoperative anxiety was moderate or high in two-thirds of patients undergoing dental implant surgeries, having a negative influence on patient satisfaction, but not affecting surgeon satisfaction. Additionally, the intravenous conscious sedation technique was considered a satisfactory technique by the surgeon to control anxiety.

Introduction: In trigeminal neuralgia, when drug treatment proves ineffective, other management options must be considered. In this context, conventional radiofrequency of Gasser’s ganglion is a safe and effective alternative. Material and Methods: We describe 5 patients with long-evolving trigeminal neuralgia subjected to conventional radiofrequency according to the Sweet technique, with a follow-up of two years. Results: Pain relief was complete after two months in all cases. One patient suffered an unexpected episode of nausea, vomiting and foul odor sensation that subsided after three days of rest and drug treatment. Three patients described non-painful hypoesthesia in the region of the treated nerve branch that subsided within three months. The patients remained free of symptoms over long-term follow-up. In one case the same radiofrequency technique had to be repeated after 21 months because of the reappearance of symptoms in the same zone, followed by immediate pain relief. Conclusions: In our series of patients trigeminal neuralgia was not controlled by drug treatment, and conventional radiofrequency targeted to Gasser’s ganglion proved very effective, with no major complications. Key words:Trigeminal neuralgia, conventional radiofrequency, trigeminal ganglion.

Objectives: In the clinical management of facial pain, a possible cervical origin must be considered. A clinical exploration is therefore essential. The disorder originates in the intimate connections between the cranial portion of the spinal cord and the trigeminal system. Although solid evidence supporting the use of radiofrequency (RF) treatment is lacking, it remains one of the management options to be taken into account. The present study evaluates the efficacy of RF in application to cervicogenic headache. Study design: We present three cases of severe facial pain arising from different cervical structures. Results: In two cases the pain originated in cervical roots C2 and C3, while in the third patient the trigger point was located at the level of the atlantoaxial joint. Pulsed RF was applied for 4 minutes at the dorsal ganglion of C2 and C3 in the first two cases, and for 8 minutes at intraarticular level in the third patient. The pain gradually subsided during the first month in all cases. The first two patients reported 70% improvement after one month, 60% improvement after 6 months, and 30-50% after one year, versus baseline. The third patient reported complete pain resolution lasting approximately 5 months, after which the pain reappeared with the same intensity as before. Conclusions: Radiofrequency is a satisfactory treatment option, affording adequate analgesia, though the effects are sometimes temporary. Key words:Cervicogenic headache, pulsed radiofrequency, analgesia.

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Topical application of DMSO 50% associated with a treatment algorithm decreased pain intensity according to the VAS score with results approaching absence of pain, and led to higher scores on the quality of life questionnaire. Topical DMSO 50% is an additional tool for use in treating CRPS I. Its side effects are scarce and it provides an overall sense of relief and lessens rigidity.

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