Intra-articular & PENG Phenol Injections for Hip Pain- Journal Club

12/27/23 • 20 min

Phenol in the treatment of Hip Pain Bonus CME Available ($15 Processing Fee) The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/wo9gDI Dr. Rosenblum discusses the use of phenol injected into the pericapsular nerve group, hip joint and outcome a isolated case reports. Also discussed, phenol, its mechanism of action and a refractory case of neuralgia paresthetica. Pain from hip cancer, pain from DVT and IPACK or articular branch of the tibial nerve block discussed for knee pain. Dr. Rosenblum discusses his ultrasound training programs, the migration of the PainExam platform to the new NRAPpain.org website and offers a testimonial from a previous ultrasound course from the student who inspired this podcast. Patients interested in scheduling a consultation with Dr. Rosenblum can call 516 482 7246 or 718 436 7246 For our Live Course Calendar, Click here Board Prep for PM&R, Pain and Anesthesiology Boards

References

Monagle, John; Ee, Joanne1. Treatment of chronic hip osteoarthritic pain with intra-articular phenol. Indian Journal of Pain 27(1):p 41-43, Jan–Apr 2013. | DOI: 10.4103/0970-5333.114866 Marcio V. Pimenta, Amanda T. Nakamura, Hazem A. Ashmawi, Joaquim E. Vieira, Hermann dos Santos Fernandes, Ultrasound-guided pericapsular nerve group and obturator nerve phenol neurolysis for refractory inpatient hip cancer metastasis pain: a case report, Brazilian Journal of Anesthesiology (English Edition), 2021, Rocha Romero, A., Carvajal Valdy, G. & Lemus, A.J. Ultrasound-guided pericapsular nerve group (PENG) hip joint phenol neurolysis for palliative pain. Can J Anesth/J Can Anesth 66, 1270–1271 (2019). https://doi.org/10.1007/s12630-019-01448-y

References

Previous Episode

Traumeel and Possible Use for Spine Pain

PainExam Podcast Show Notes: Exploring Traumeel as an Alternative for Back Pain Relief

Cl aim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/HoEWFd

Board Prep and Continuing Education

Introduction:

Today, Long Island Based Pain Physician David Rosenblum, MD delves into the latest advancements and alternative treatments for pain management.
In today's episode, we shine a spotlight on Traumeel®, a homeopathic alternative gaining traction for its anti-inflammatory properties, with fewer reported side effects compared to corticosteroids.

Understanding Traumeel:

Traumeel, a fixed combination of diluted plant and mineral extracts, has been available over-the-counter in Europe for over 60 years.
Contrary to corticosteroids, Traumeel's popularity has surged due to its limited side effect profile, with reported contraindications primarily linked to allergies [9].

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Scientific Insights:

A study by Lussignoli et al. demonstrated Traumeel's efficacy in decreasing systemic interleukin-6 production and reducing edema, countering an unregulated inflammatory response [10].
In vitro studies revealed Traumeel's inhibition of pro-inflammatory mediators (IL-1β, TNFα, IL-8) in immune cells, suggesting its potential in stabilizing the immune system [8].
Notably, Traumeel's effectiveness seems to surpass the sum of its individual components, indicating a synergistic interaction [9-10].

Clinical Applications:

Traumeel has shown efficacy comparable to nonsteroidal anti-inflammatory drugs (NSAIDs) in treating various inflammatory conditions.
It is available in oral, topical, and injectable preparations, making it a versatile option for pain relief [8-9].

Research Gaps and Potential:

Despite its established use, current research lacks information on Traumeel's efficacy in epidural injections for short-term back pain relief.
No studies have compared Traumeel to corticosteroid injections, although the TRARO study protocol proposes a potential avenue for comparison in rotator cuff syndrome patients [11].

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Clinical Cases:

Five patients seeking back pain relief opted for Traumeel injections due to either a contraindication to or a preference against steroids.
This real-world scenario lays the groundwork for further exploration into Traumeel's efficacy in epidural injections, providing additional pain-relieving options for patients unable to tolerate corticosteroid injections.

Conclusion:

Traumeel presents a promising alternative for pain management, particularly in cases where corticosteroids may be unsuitable, however the FDA has yet to approve it and therefore it has failed to gain traction in the US. [14]
As we wrap up, stay tuned for future developments in the research landscape surrounding Traumeel and its potential role in enhancing pain relief options.

Disclaimer:

Consult with a healthcare professional before considering any alternative treatments. The information provided in this podcast is for educational purposes only and does not replace medical advice.

David Rosenblum, MD President, NRAP Academy Clinical Assistant Professor Department of Anesthesiology SUNY Downstate Medical Center Director of Pain Management Maimonides Medical Center

References 1. Cassidy JD, Carroll LJ, Côté P: The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults....

Next Episode

Ultrasound Guided Nerve Blocks in the Treatment of Headaches

Exploring the Role of Ultrasound in Headache Evaluation and Treatment

A Journal Club based on Dr. Andrea Trescott's article:

Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253.

Click Here to Claim CME for reflecting on content presented in this journal club.

David Rosenblum, MD

Accepting New Patients

Patients Interested in scheduling a consultation with Dr. David Rosenblum can call

516 482 7246 (Garden City) or 718 436 7246 (Brooklyn)

In this Podcast, Dr. Rosenblum discusses patient's in his practice who responsed to ultrasound guided nerve blocks in the treatment of headaches. He discusses the use of ultrasound injections as opposed to medication to manage the pain and references Dr. Trescott's comprehensive article on the various nerves and clinical presentations of headaches related to terminal nerve entrapment or irritation.

Dr. Rosenblum discusses

Supraorbital Neuralgia
Auriculotemproal Nerve
Anatomy
Clinical presentation
Interventional Pain Therapies

Summary of Dr. Trescott's Article and Key Points:

Headaches, affecting 28 million people in the US, pose a significant burden on society in terms of medical costs and lost labor. They are complex neurologic disorders with diverse origins and causes.
Headaches are often viewed as the primary pathology, but they are fundamentally a symptom. Understanding them is an evolving science, and their patterns can be recognized for effective diagnosis and treatment.
In 2003, Pareja et al proposed the term "epicrania" for headaches triggered by extracranial causes, suggesting a link between intracranial components and extracranial nerves.

Peripheral Triggers and Plastic Surgery:

Plastic surgeons noted relief of migraines through corrugator muscle resection and botulinum toxin injection, indicating peripheral headache triggers.
Severe migraines post-head or neck injury may have an extracranial origin, suggesting peripheral nerve irritation. Traditional migraine medications may offer modest relief.
Primary treatment involves inhibiting nerve irritation through interventional pain techniques, turning off the pain origin and associated migraine centers.

Ultrasound Advantages:

Evaluation and injection of nerves have traditionally used landmarks and fluoroscopic images, but ultrasound offers unique advantages.
Nerves often travel with arteries, potentially contributing to "throbbing" pain. Ultrasound provides a more precise and dynamic visualization of these structures.

Exploring Extracranial Causes:

The International Classification of Headache Disorders (ICHD) categorizes headaches as primary or secondary. While valuable, it broadly defines peripheral nerve contributions as "Other Terminal Branch Neuralgias."
The study of extracranial peripheral nerve entrapments and dysfunction reveals overlap between ICHD-defined headaches and potential nerve entrapments causing these pain patterns.
Collaboration with disciplines like pain management enriches the understanding and treatment options for headaches.

Conclusion:

Headaches, often seen as isolated intracranial phenomena, may have extracranial triggers. Understanding and treating these triggers, especially through ultrasound-guided techniques, present a promising avenue in headache management.

NRAP Academy also offers: