Thoracic subarachnoid alcohol neurolysis for post herpetic neuralgia?

[Ligament]

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Saw an 80 year old patient today who had two thoracic subarchnoid neurolysis sessions with EtOH for refractory PHN. Anybody with any experience doing this for benign pain? I've never seen this in a benign pain setting.

It did not help, but neither did prialt, IT morphine, pulsed RF intercostal nerves, multi level intercostal nerve blocks, thoracic ESIs, Qutenza, multiple meds. He has a pacemaker and a poor scs candidate (CHF, COPD, DM). What a mess. I discussed hospice with him.

 

[PinchandBurn]

Saw an 80 year old patient today who had two thoracic subarchnoid neurolysis sessions with EtOH for refractory PHN. Anybody with any experience doing this for benign pain? I've never seen this in a benign pain setting.

It did not help, but neither did prialt, IT morphine, pulsed RF intercostal nerves, multi level intercostal nerve blocks, thoracic ESIs, Qutenza, multiple meds. He has a pacemaker and a poor scs candidate (CHF, COPD, DM). What a mess. I discussed hospice with him.

Try intrathecal methylprednisolone??

few case reports out from Japan. Also on pubmed, there's a case report by Candido

 

[Ligament]

Hmmm hadnt thought of that. will look into it. Thanks

 

[PinchandBurn]

Hmmm hadnt thought of that. will look into it. Thanks

forgot to tell ya

dont just give it intrathecal in teh suspension it comes with. You've got to suspend the vial for 20min or so (i havent read teh article in a while), so that the PEG floats to the top or something.

 

[Ligament]

I should clarify:

subarachnoid alcohol neurolysis for post herpetic neuralgia was already done for this patient, twice, by another physician. Neither time with benefits. So I'm not planning on repeating.

 

[facets]

I did that once along with lidocaine, basically a spinal. It was a PIA because she was at my asc for 5 hours but ut worked. She had PHN for years

 

[Aether2000]

I know of no physicians that would have attempted thoracic subarachnoid alcohol neurolysis for benign chronic pain...that seems bizarre.

 

[TX PAIN DOC]

I have had success with spinal cord stimulation for refractory PHN.

 

[Jcm800]

I know of no physicians that would have attempted thoracic subarachnoid alcohol neurolysis for benign chronic pain...that seems bizarre.

late to the thread, but agree...

I saw this once ( i didnt do it, i was a resident and was around, i should say) and it was end of the road cancer, disaster...

even then, the complications are severe, and frequent, from what i understand. To me, this is something that basically nobody does anymore for anything.

 

[Ligament]

This is also my understanding, that it is only done for terminal pain. We did it in the cancer hospital I did fellowship in. It was done by a physician near Seattle in 2010. I was surprised to see it.

 

[NOSfan]

IT Baclofen may work if he still has his catheter in place. Never tried it but here's the article.

http://www.painphysicianjournal.com/2004/july/2004;7;345-347.pdf

 

[Ligament]

I'm going to consider the IT baclofen and methylprednisolone. Thanks for the pearls. Anything else? He also failed intradermal botox and qutenza BTW.

 

[PinchandBurn]

I'm going to consider the IT baclofen and methylprednisolone. Thanks for the pearls. Anything else? He also failed intradermal botox and qutenza BTW.

keep us updated when you do this finally!

 

[lobelsteve]

THrow a lead in the gutter over the root with the bum DRG.
Program for frequency or it will not feel good.

Way easier than anything else done or anticipated.

My algorithm:

1. Lyrica and Lidoderm
2. Pamelor or Cymbalta or Keppra
3. ICNB
4. T12-L1 ESI with cath to level
5. SCS trial