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Trigeminal neuralgia is a common condition among the adult population. Its diagnosis is primarily clinical and simple enough in typical cases featuring brief, electric-shock like paroxysmal pain triggered by harmless gestures within the trigeminal nerve territory. Laboratory and imaging tests are not available to confirm its occurrence. In addition to the paroxysmal pain forms, there are also other atypical forms featuring continuous background pain between paroxysms. In these cases, differential diagnosis with other neuropathic and non-neuropathic facial pain can be challenging. Trunk functional tests, such as the blink reflex, have been shown in some circumstances to be decisive in arriving at a correct diagnosis, as in the clinical case we present.

El dolor es una causa importante de sufrimiento físico y emocional. El tratamiento médico de los pacientes con dolor crónico refractario es un gran reto. Se trata de una paciente de 19 años con un cuadro radicular compresivo secundario a Hernia discal L5-S1 derecha, que se le aplicó una discectomía L5-S1 por técnica de Caspar. Al mes de evolución regresa con igual sintomatología. A pesar de múltiples terapias farmacológicas y procederes intervencionistas, el dolor neuropático no mejora, después de múltiples estudios y discusiones en colectivo se determina la posibilidad de la colocación de un neuroestimulador medular, proceder que se lleva a cabo con mejoría considerable de su cuadro doloroso.

Glossopharyngeal neuralgia (GN) is a quite uncommon neuropathic face pain syndrome. In the classic form pain occurs as recurring paroxysmal, unilateral, short time lasting and shooting or electric shock-like attacks in the sensory area of the ninth cranial nerve. The secondary form can be caused by surgery injuries, cancer, infections, vascular malformations or elongated styloid process (Eagle syndrome). We present the case of a patient with GN occurred eight months after stereotactic radiosurgery of acoustic neuroma. Pain was drug-resistant but responded significantly to high voltage pulsed radiofrequency CT-guided treatment. No complications were reported neither throughout the procedure nor in the immediate postoperative period.

Persistent idiopathic facial pain (PIFP) is the current terminology for “atypical facial pain” (AFP), and is characterized, according to recent Classification, by recurring daily pain for more than two hours per day over more than three months, in the absence of clinical neurological deficit. Pain is initially confined but may subsequently spread. When present intraorally, PIFP has been termed “atypical odontalgia” (AO). According to the International Classification of Headache Disorders (ICHD-3), AO is included as a subtype of PIFP and most researchers have concluded that it is a painful traumatic trigeminal neuropathy. The pathophysiology of PIFP is still mysterious, however neuropathic mechanisms may be relevant. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. They include facial myofascial pain, atypical trigeminal neuralgia, painful traumatic trigeminal neuropathy and orofacial migraines. For this reason and to rule out psychiatric comorbidities interdisciplinary collaboration is essential. Due to enigmatic pathophysiology the PIFP’s treatment is unclear. Probably the best outcomes are obtained with a combination of pharmacologic and no pharmacologic treatments, reserve interventional treatment for selected cases.

A high percentage of patients with neoplasm develop osteolytic metastases that, in addition to causing pain, expose them to the risk of fractures and nerve compressions. Standard therapies with chemotherapy, radiotherapy and bisphosphonates are not always effective in controlling pain and the surgical treatment is reserved to patients in fair general conditions and with a long-life expectancy because of its high morbidity and mortality. Opioid medications may also not be well tolerated due to the side effects they cause. Recently, minimally invasive techniques have been introduced to control pain by acting quickly and with few complications. One of the most used is radiofrequency thermoablation (RFA) which, through the introduction of a thermal probe into the bone, causes metastasis necrosis and allows pain control.

The authors present the different kinds of pain following the spinal cord lesions (neuropathic, nociceptive, somatic, visceral); they describe the alterations that occur on spinal cord, brain and periphery; the methods to define the kinds of pain and to evaluate the pain intensity; the strumental and pharmacological treatments for pain relief. In detail data on the efficacy of spinal neurostimulation are compared with data on the efficacy of baclofen intrathecally administered. Based on results of his studies and on international literature data, the authors conclude that efficacy of treatment with baclofen intratecally administered with a programmable pump is higher than spinal neurostimulation treatment.

The purpose of this study is to evaluate the efficacy and safety of suprascapular nerve pulsed radiofrequency, in patients affected by chronic shoulder pain. In the study were included sixteen (16) patients affected by chronic shoulder pain for a period of more than six months. Of which: 3 suffering from frozen shoulder, 5 for lesions (injury) of the rotator cuff, and 8 for osteoarthritis. After a favorable response to a diagnostic suprascapular nerve block (pain relief > 50% NRS), PRF neuromodulation was performed. Shoulder pain and quality of life were assessed using a Numeral Rating Scale (NRS), before the diagnostic block and every month after PRF neuromodulation for a 6-month period. The mean NRS score in all (16) patients before PRF was 6.75±1.05, and the scores at 6-month follow-up were 1.30±0.50. A significant pain reduction (p

Trigeminal neuralgia is a neuropathic pain which involves the fifth cranial nerve. The pain is severe and paroxysmal like electric shocks and lasts from a few seconds to two minutes. Although many patients with multiple sclerosis complain of trigeminal neuralgia, its cause and mechanism are still debated. Usual therapy for trigeminal neuralgia is with antiepileptic drugs such as carbamazepine or oxcarbazepine. These medications have a good early pain relief, often, however, adverse effects force the patient to opt for the therapeutic percutaneous surgery procedures as radiofrequency trigeminal rhizotomy (CRFT) which has a high rate of early pain relief. In case CRFT were unfeasible, a pulsed radiofrequency neuromodulation procedure applied to pterygopalatine ganglion could be an effective option. We present a case of 46-year-old male suffering from I branch trigeminal neuralgia and multiple sclerosis refractory to conservative pharmacological treatment. After the technical failure of CRFT, he successfully underwent a pterygopalatine pulsed radiofrequency (PRF-PPG) procedure.

Sluder's neuralgia or sphenopalatine ganglion neuralgia is a pain syndrome first described by Sluder in 1908. The clinical picture is characterised by pain starting around the eye and the route of nose. Typically the pain is accompanied by parasympathetic disautonomic signs such as lacrimation and/or rhinorrhea. However, many official headache classifications do not mention the Sluder's neuralgia at all, which is instead classified as a cluster headache (CH). In case of resistance to pharmacological management pain the physician could recur to sphenopalatine ganglion (GSP) neurolytic block with continuous radiofrequency (CRF) or its no ablative alternative with pulsed radiofrequency (PRF). We are presenting a case of a 16-year-old woman who suffered from a typical Sluder's neuralgia successfully treated with GSP PRF.

Opioid switching is a therapeutic procedure used in pain management as a method to improve analgesic response and/or reduce adverse side effects. The rationale behind opioid substitution is the incomplete cross-tolerance between opioid. We report the case of an asian 51-year-old man with cancer pain unresponsive to oxycodone. In this case we hypothesize that the lack of response to oxycodone is linked to a phenomenon of pharmacokinetics tolerance.