oro-facial pain - belgian pain society of cluster headache patients = smokers ! ... cervicogene...
TRANSCRIPT
Koen Lauwers, MD, FIPP BPS 2014
Smoking and physical inactivity
Pain 153 (2012) : 56-61, Risk factors for medication –overuse headache ; 11 year follow up , 27000 patients
P(medication-abusus induced headache= MOH) X2
90% of cluster headache patients = smokers !
Koen Lauwers, MD, FIPP BPS 2014
Stop the pain !
Stop smoking ! Start moving !
Google : > 20 miljon references The Cleveland Clinic-website of well- being in Ohio : 1.The Journal of Head and Face Pain, 48: 545–552. doi: 10.1111/j.1526-4610.2007.01037.x. Accessed 6/17/2013. 2.JAMA. 2012;308(18):1889-1896. doi:10.1001/jama.2012.14276. Accessed 6/17/2013.
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Koen Lauwers, MD, FIPP BPS 2014
1. RF treatment : what does it do ?
2. Where do we place our needle(s) ?
3. How do we work ?
4. What are de main complications ?
5. Do we have good results ?
6. Future ?
7. What did you learn ?
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1. Radiofrequency ( RF ) treatment ?
Koen Lauwers, MD, FIPP BPS 2014
= >100 years old = high frequency alternating current distal T /Voltage/Amperage controlled treatment
change of structure - different = safe RF = neurodestructive (high T) PRF =pulsed radiofrequency treatment = neuromodulative
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Koen Lauwers, MD, FIPP BPS 2014
2. Where do we place our needles ?
1. Trigeminal ganglion 2. Sphenopalatine ganglion 3. Cervical facetinnervation 4. Cervical dorsal root ganglion 5. Stellate Ganglion 6. Superficial-peripheral ( nervus occipitalis maior, n.supra-orbitalis, n.mandibularis, …) 7. Intra-articular ( TMJ )
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Koen Lauwers, MD, FIPP BPS 2014
RF: 3x 60’ 60-65-70°C under wake-up anesthesia
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1.RF treatment of Trigeminal ganglion :
4. PRF of cervical dorsal root ganglion :
Koen Lauwers, MD, FIPP BPS 2014
PRF cervical DRG : 2 Hz, 45 V, < 42°C, 2 minutes
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C6
C6
5. Diagnostic and RF treatment of Stellate Ganglion :
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Needle in tunnelvision RF 1 minute 80°C at C7
Diagnostic at C6 Black = contrast
Koen Lauwers, MD, FIPP BPS 2014
V1 V2 V3
Cervical 2-3
Cervical 3-4-5
Cervical 5-6
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Sensoric innervation of head/face skin
6. Sensoric innervation of head/face skin
Koen Lauwers, MD, FIPP BPS 2014
Greater occip. n. (C2)
Third occip. n. (C3)
Greater auric n. (C 2,3)
Lesser occip. n. (C 2)
V1
V2
V3
V0
Vc C2
C3
Transv. cut n. of neck (C 2,3)
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Koen Lauwers, MD, FIPP BPS 2014 25
Pulsed RF treatment of peripheral nerves 2 Hz, 45 V, max.42°C- > 2 minutes
Koen Lauwers, MD, FIPP BPS 2014
3. How do we work ?
- Most important : interdisciplinary- good selection of patients
- Sterile conditions- disposable needles/sets-informed consent - Operating theatre ( lead protection)
- X-ray (conventional and/or CT guided) - echography
- Daycare or one night in hospital ( depending on schedule)
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Koen Lauwers, MD, FIPP BPS 2014
4. Main (possible) complications of interventional (RF) treatment :
- General : - Bleeding :
- superficial - Deep : IC bleeding – choakmuscle bleeding- nosebleeding
- Infection - Specific :
- Gasser :
facial hypesthesie ( 50%)-masseter muscle weakness ( 10%), dry eyes ( 10%?)
- Sphenopalatine ganglion : bradycardia, palatine or dental numbness, max.nerve lesion
- Stellate ganglion : IA vertebralartery injection/death – pneumothorax - Horner
- Facetdenervation : burning pain ( temporary )
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5. Results :
Koen Lauwers, MD, FIPP BPS 2014
- Trigeminal nerve RF treatment : very high initial succes for TN - less duration than Janetta Solitary V3 > solitary V2 or multi V pain - RF sphenopalatine ganglion : episodic > chronic cluster headache - RF of cervical facet innervation for cervicogenic headache :
high succes rate if good patient selection and if major Occipital nerve
Lopez et al Neurosurg 2004; Tatli et al. Acta Neur (Wien) 2008
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Koen Lauwers, MD, FIPP BPS 2014
diagnose behandeling Evidentie ratio
Trigeminusneuralgie RF van het ganglion 2B+
Clusterhoofdpijn RF pterygopalatinum
2C+
Persisterende idiopath.aangezichtspijn
RF pterygopalatinum
2C+
Cervicogene hoofdpijn Injectie NOM cortico
1B+
RF facetten mediale takken
2B+-
Injectie AA-gewricht
2C- : negatieve aanbeveling
PRF van het C2-3 DRG
Studie verband
WAD-whiplash RF facetten mediale takken
2B+
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6. (near) Future ?
Koen Lauwers, MD, FIPP BPS 2014
- More interdisciplinary work and prevention of pain = communication + explanation = better selection for RF treatment ! - Technical : less invasive
less radiationdoses – more echography(?) better needles, (more perifepheral?) optimalization electrical current parameters ( rTMS = repititve transcranial magnetic stimulation) - Medical
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7. Conclusion : what did you learn ?
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1. Prevention of pain = key stone of our job ( communication on life-style) 2. There is rather good evidence for treating patients wiht oro- facial pain by RF interventional paintreatment 3. Key-point = patient selection by interdisciplinary work 4. Rf treatment is safe in experienced hands