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Treatment of post-traumatic pain, and autonomic and muscular dysfunction by ganglion impar block and medial branch block of the facet joints: A case report
Smärtkliniken i Umeå, Umeå, Sweden.ORCID-id: 0000-0001-6571-5830
Section for Specialized Pain Rehabilitation, Department of Rehabilitation Medicine , Skåne University Hospital and Department of Health Sciences, Lund University, Lund, Sweden.
2012 (Engelska)Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 3, nr 4, s. 228-240Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: Patients exposed to whiplash trauma are at risk of developing pain and dysfunction of the neck and shoulder. Although rarely discussed in the literature, some patients also develop autonomic dysfunction.

Case presentation: A previously healthy 41-year-old woman was involved in a “head-on” car crash. During the following 3 years she developed severe and complex post-traumatic pain syndrome, which consisted of neck pain, lumbar pain, sensory-motor dysfunction, and myoclonic muscular contractions. Despite pharmacotherapy, physiotherapy, and rehabilitation, her condition worsened, resulting in severe disability. Fourteen years after the car crash, an interventional pain therapy program was started, which consisted of sympathetic ganglion impar block and medial branch blocks of facet joints at different levels. These treatment strategies ultimately normalized her sensory-motor dysfunction, reduced her autonomic dysfunction, and stopped the myoclonic muscular contractions.

Conclusion: This case highlights a possible interaction between the pain-generating facet joints, the somatosensory nervous system, and the autonomic/sympathetic nervous systems. The case also highlights the importance of identifying autonomic dysfunction in patients with persisting pain syndromes.

Implications: This complex case shows that many clinical phenomena cannot be explained using our present knowledge of pain mechanisms. We hope that readers who have observed similar cases can learn from our case, and are encouraged to publish their observations.

Ort, förlag, år, upplaga, sidor
Elsevier, 2012. Vol. 3, nr 4, s. 228-240
Nyckelord [en]
Autonomic dysfunction, Facet joints, Ganglion impar, Case report, Whiplash, Pain
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
URN: urn:nbn:se:umu:diva-202598DOI: 10.1016/j.sjpain.2012.07.002ISI: 000217906500010PubMedID: 29913870Scopus ID: 2-s2.0-84867171700OAI: oai:DiVA.org:umu-202598DiVA, id: diva2:1725912
Tillgänglig från: 2023-01-12 Skapad: 2023-01-12 Senast uppdaterad: 2023-01-12Bibliografiskt granskad

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