Dextrose Prolotherapy for Occipital Neuralgia Management
Abstract
Background: Occipital neuralgia defined as a pain such as being stabbed in the skin according to the dermatomes of the greater occipital nerves (GON) and lesser occipital nerves (LON).
Case: An 80-year-old male patient diagnosed with occipital neuralgia. Previously, patients were diagnosed with lung cancer six months ago and planned for follow-up chemotherapy. Patient already receive medications including paracetamol, Non-steroidal anti-inflammatory drugs (NSAIDs), minor tranquilizers, and antidepressants, but the pain still exist. Patient then scheduled to receive blocks of GON and LON-ultrasound-guided using plain lidocaine 2% and steroids dexamethasone 10 mg. Fifteen days later, patient receive perineural deep injection along with prolo-hydrodissection in GON and LON using dextrose 15% and local anesthesia lidocaine plain 2% with a volume of 3 cc each nerve. The intervention give a positive outcomes, pain is reduced with NRS rest 0-1, NRS motion 2-3, hearing improves, and the noise in the ear disappears. The patient can sleep using a pillow.
Conclusion: Block GON and LON, perineural deep injection along with prolo-hydrodissection provides a positive outcome for occipital neuralgia pain management. This case showed an opportunity for pain specialist to develop pain intervention based on prolotherapy.
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Barna S, Hashmi M. Occipital neuralgia. Pain Manag Rounds. 2004;1(7):1-6.
Bano I, Chaudhary W. Interventional pain management techniques can be helpful in headache management. Anaesth, pain intensive care. 2011;15(1):60-64.
Azzahra ZA, Purwanti E, Hidayati HB. Design of Expert System As a Support Tool for Early Diagnosis of Primary Headache. MNJ (Malang Neurol Journal). 2017;3(2):78-87. doi:10.21776/ub.mnj.2017.003.02.5
Van Zundert J, Hartrick C, Patijn J, Huygen F, Mekhail N, van Kleef M. Evidence-Based Interventional Pain Medicine According to Clinical Diagnoses. Pain Pract. 2011;11(5):423-429. doi:10.1111/j.1533-2500.2011.00490.x
Liu A, Jiao Y, Ji H, Zhang Z. Unilateral occipital nerve stimulation for bilateral occipital neuralgia: A case report and literature review. J Pain Res. 2017;10:229-232. doi:10.2147/JPR.S125271
VanderHoek MD, Hoang HT, Goff B. Ultrasound-guided greater occipital nerve blocks and pulsed radiofrequency ablation for diagnosis and treatment of occipital neuralgia. Anesthesiol Pain Med. 2013;3(2):256-259. doi:10.5812/aapm.10985
Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-1006. doi:10.15585/mmwr.mm6736a2
Manolitsis N, Elahi F. radiofrecuebncia Arnold. Published online 2014:709-718.
Trescot AM. Peripheral nerve entrapments: Clinical diagnosis and management. Peripher Nerve Entrapments Clin Diagnosis Manag. 2016;(January):1-902. doi:10.1007/978-3-319-27482-9
Choi I, Jeon SR. Neuralgias of the head: Occipital neuralgia. J Korean Med Sci. 2016;31(4):479-488. doi:10.3346/jkms.2016.31.4.479
Reeves D, Rabago D. Therapeutic Injection of Dextrose: Prolotherapy, Perineural Injection Therapy and Hydrodissection. Essentials of Rehabilitation Practice and Science. Published 2021. Accessed March 27, 2021. https://now.aapmr.org/therapeutic- injection-of-dextrose-prolotherapy-perineural-injection-therapy-and- hydrodissection/
Trescot A, Brown M. Peripheral nerve entrapment, hydrodissection, and neural regenerative strategies. Tech Reg Anesth Pain Manag. 2015;19(1-2):85-93. doi:10.1053/j.trap.2016.09.015
Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159. doi:10.4137/CMAMD.S39160
DOI: http://dx.doi.org/10.21776/ub.jap.2021.002.03.02
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