Die Behandlung des komplexen regionalen Schmerzsyndroms der oberen Extremität mit wiederholter Lokalanästhesie des Ganglion stellatum

Abstract

Two female patients were referred to us with a complex regional pain syndrome (CRPS) of the upper limb. One patient developed a CRPS type 1 after a radius fracture, the other presented a CRPS type 2 after a wrist trauma with a nerve injury of N. ulnaris. Both patients had progressive pain in spite of medical treatment (NSAID, Gabapentine, Calcitonine), physiotherapy, occupational therapy and osteopathy. In addition to pain they also showed the typical autonomic symptoms like oedema, hyperhidrosis, disturbances of skin colour and temperature and a severely limited motility of wrist and fingers. The clinical symptoms of both types of CRPS are identical and not restricted to the peripheral nerve distribution. The sympathetic nerve system is not only involved in the pain mechanism with reflectory processes in the segment and with the sympathetic afferent coupling, it also takes part in the neuroplasticity and in the neurogenic inflammation. The logical therapeutic intervention is therefore to normalize the hyperactivity of the sympathetic nerve systems with local anaesthetics. This regulation is done with injections to the stellate ganglion if upper limbs are affected (affections of lower limbs are treated with injections to the lumbar sympathetic trunk). Repeated injections to the stellate ganglion caused immediate improvement of pain and other symptoms in both patients.

Long-term results of therapeutic local anesthesia (neural therapy) in 280 referred refractory chronic pain patients

“…These results are supported by a Health Technology Assessment report [ 4 ] and other studies [ 36 – 38 ]. Furthermore, NT, which has been empirically developed in normal, everyday clinical practice, is in line with modern knowledge of the neurophysiology of pain and neurogenic inflammation [ 7 , 26 , 29 , 32 , 34 , 39 – 42 ].…”

“…Using local anesthetics (NT) these different levels can be accessed directly and logically: by applying an impulse (needle prick) and by disrupting a vicious circle (local anesthetic). Repeated application can lead to the “extinction” of the engrammatically stored pathological irritability of the sympathetic nervous system and to the restoration of normal tissue perfusion [ 9 , 20 , 34 ]. The local anesthetic can disrupt the escalating vicious circle of nociceptor activity – sympathetic excitation – circulation disturbance – neurogenic inflammation – muscle hardening, etc.…”

Neuraltherapie: Injektion an das Ganglion stellatum

“…Neue physiologische Reize werden dann pathologisch beantwortet. Mittels Lokalanästhesie können solche Informationen gelöscht werden, wie auch neue Arbeiten zeigen [19,22].…”

Local Anesthetics, Procaine, Lidocaine, and Mepivacaine Show Vasodilatation but No Type 1 Allergy: A Double-Blind, Placebo-Controlled Study

“…Nowadays, more and more data on the so-called “alternative effects” of LAs is being published. With the increase in data, a better understanding of the broad spectrum of therapeutic uses of LAs comes, for example, its anti-inflammatory [ 20 ] and immunomodulating properties [ 21 ], applications in oncology [ 22 , 23 ], and uses in treating chronic CRPS [ 24 ] as well as chronic pain and functional disorders [ 25 ]. The therapeutic use of LAs, also known as neural therapy (NT) or therapeutic local anesthesia (TLA), is more relevant than ever [ 2 ].…”