Ganglion Impar Neurolysis in the Management of Pelvic and Perineal Cancer-Related Pain

Ferreira, Filipa; Pedro, Ana

doi:10.1159/000505181

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…As a more definitive target, GIB may be more beneficial in pain reduction than CESI, which acts as a peripheral mechanism through the sacrococcygeal nerves. Although GIB generally provides an adequate clinical response in patients with coccygodynia from to non-malignant causes, ganglion impar neurolysis or radiofrequency ablation procedure can be applied in patients with persistant pain mostly seen in pelvic and perineal cancers [ 18 ]. Neurolytic blocks consist of the destruction of nervous tissue usually through the injection of alcohol or phenol.…”

Section: Discussionmentioning

confidence: 99%

Comparison of treatment outcomes in chronic coccygodynia patients treated with ganglion impar blockade versus caudal epidural steroid injection: a prospective randomized comparison study

et al. 2022

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Background: Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia. Methods: This study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups: the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively. Results: A total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month. Conclusions: Although GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.

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Section: Discussionmentioning

confidence: 99%

Comparison of treatment outcomes in chronic coccygodynia patients treated with ganglion impar blockade versus caudal epidural steroid injection: a prospective randomized comparison study

et al. 2022

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“…Палець поміщали в пряму кишку, щоб виявити неправильно розташовану голку. У цій серії випадків отримано добрі результати щодо зниження інтенсивності болю, про що повідомили пацієнти [13,14]. http://theunj.org У минулому для інтервенцій НВ використовували зігнуті та вигнуті голки, що асоціювалося зі значним дискомфортом, пошкодженням тканин, високим ризиком перфорації прямої кишки, періостальною ін'єкцією та високою частотою невдач [15].…”

Section: матеріали і методиunclassified

Minimally Invasive Interventions on Ganglion Impar in Treatment of Patients with Coccygodynia

Romanukha,

Biloshytsky

2024

Ukr Neurosurg J

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Chronic pelvic pain (CPP) is usually treated conservatively, but in patients who do not respond to treatment, ganglion impar (GI) interventions are used as an alternative way to reduce pain. Objective ‒ to study the course of pain syndrome and functional status in patients with coccygodynia (CD) and CPP during the application of minimally invasive interventions on GI. Materials and methods. The analysis of the results of 56 interventions on GI in 50 patients was performed. Inclusion criteria were patients with coccyx pain for ≥3 months aged 23 to 71 years (mean age 47.9±14.8years) who did not respond to conservative treatment methods. 15 (35.7%) of the study participants were male and 27 (64.3%) were female. Interventions were performed on the patients according to five different methods, which were divided into two groups: the first group (n=34) ‒ GI block (GIB) with a local anesthetic and a steroid (patients with CD in whom medical conservative methods of treatment were not effective). The second group (n=14) consisted of persons with recurrent pain syndrome, resistant forms of CD and CPP, including after previously performed steroid injections: n=2 – neurolysis of GI with ethyl alcohol; n=2 – neurolysis of GI by phenol; n=3 – radio frequency modulation of GI; n=7 – radiofrequency ablation of GI. Results. 14.0% of all study participants had post-traumatic CD (history of falling on the coccyx), the vast majority of 86.0% ‒ idiopathic CD. Pain intensity was significantly lower post-intervention compared to baseline VAS mean of 7.6±1.5 cm: 2.5±0.9 cm one-week post-procedure, 1.5±1.9 cm one month, 1.3±1.5 cm three months, 2.1±1.2 cm six months. The average score according to the Karnovsky Scale (KS) before and after the procedure was 73.3±6.3% and 83.9±4.9%, respectively. Conclusions. Interventions on ganglion impar are an effective method of treating patients with coccygodynia of various etiology, which significantly reduce pain according to the VAS scale (p<0.001) and improve the quality of life according to the KS (p<0.001) in dynamics after 1, 3, 6 months. Minimally invasive interventions on ganglion impar make it possible to reduce tissue trauma, to quickly recover for patients after the procedure, and to minimize any complications. In the first and second groups of the study, there was a decrease in the pain on the VAS from 8.0 cm to 2.0 cm (p<0.0001) and from 7.0 cm to 2,7 cm (p<0.001) before and after the procedure, respectively. In the first and second groups of the study, there was an improvement in the indicator of functional status according to the KS from 70% (95% сonfidence interval (CI) 60‒90%) to 90% (95% CI 70‒100%, p<0.0001) and from 70% (95% CI 70‒90%) to 90% (95% CI 80‒100%, p=0.001) before and after the procedure, respectively.

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“…Ganglion impar neurolytic block is a great option for patient with pelvic organ cancer causing perineal and rectal pain. It has been shown to improve pain and function and improve patient satisfaction (32).…”

Section: Ganglion Imparmentioning

confidence: 99%

Minimally-invasive pain management techniques in palliative care

et al. 2022

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Pain is a common source of suffering for seriously ill patients. Typical first-line treatments consist of lifestyle modifications and medication therapy, including opioids. However, medical treatments often fail or are associated with limiting systemic toxicities, and more targeted interventional approaches are necessary. Herein, we present options for minimally invasive techniques for the alleviation of pain in palliative patients from a head-to-toe approach, with a focus on emerging therapies and advanced techniques.Head and neck: image-guided interventions targeted to sympathetic ganglia of the head and neck, such as sphenopalatine ganglion (SPG) and stellate ganglion, have been shown to be effective for some forms of sympathetically-maintained and visceral pain. Interventions targeting branches of cranial nerves and upper cervical nerves, such as the glossopharyngeal nerve (GPN), are options in treating somatic head and face pain. Abdominal and Pelvic: sympathetic blocks, including celiac plexus, inferior hypogastric, and ganglion impar can relieve visceral abdominal and pelvic pain. Spine and somatic pain: fascial plane blocks of the chest and abdominal wall and myofascial trigger point injections can be used for somatic pain indications.Cementoplasties, such as kyphoplasty and vertebroplasty, are used for pain related to bony metastases and compression fractures. Tumor ablative techniques can also be used for lytic lesions of the bone. Spinal cord stimulation (SCS), intrathecal drug delivery systems (IDDS), and cordotomy have also been used successfully in patients requiring advanced options, such as those with significant spinal, ischemic, or visceral pain.

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Ganglion Impar Neurolysis in the Management of Pelvic and Perineal Cancer-Related Pain

Cited by 8 publications

References 14 publications

Comparison of treatment outcomes in chronic coccygodynia patients treated with ganglion impar blockade versus caudal epidural steroid injection: a prospective randomized comparison study

Comparison of treatment outcomes in chronic coccygodynia patients treated with ganglion impar blockade versus caudal epidural steroid injection: a prospective randomized comparison study

Minimally Invasive Interventions on Ganglion Impar in Treatment of Patients with Coccygodynia

Minimally-invasive pain management techniques in palliative care

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