Holy Spirit University, Lebanon
Souheil Chamandi, M.D. Head of pain clinic, Holly Spirit University (USEK) Medical Faculty Anesthesia Department, Tony Matta, MD. PGY2 Anesthesia and Reanimation, Holy Spirit University (USEK) Medical Faculty Anesthesia Department.
Introduction: Drug abuse and addiction on pain killers and opioid like drugs is common in patients suff ering from chronic pain problems. Pain killers, tramadol and many opioid like drugs are used and abused frequently and on regular basis to elevate the pain due to chronic health issues. Background: Th rough years in our pain clinic we used nerve block in the management of chronic pain such as: Migraine (intractable headache), Sciatica with or without Myofacial pain syndrome, Refl ex sympathetic dystrophy. Methods: Patients suff ering from sciatica are chronic users of pain killers, opioid like drugs and many of them are on antidepressants (SSRI, SNRI). Th ese patients use those drugs to relieve them from their back pain to be able to function and manage their daily activities; which then leads them to addiction. Patients were treated for lumbar radiculopathy. Epidural infi ltration was performed on L3-L4; L4-L5; L5-S1 based on the location of the radiculopathy. In this group of patients with back pain, some had positive lumbar myofacial syndrome associated to their sciatica and were treated with epidural infi ltration and infi ltration of their myofacial trigger points. As for patients with intractable migraine, most of them were on tricyclics such as tryptizol and use frequently drugs containing codeine and tramadol. For this group of patient we use the nerve block: A greater occipital nerve block along with the lesser occipital nerve block, using a nerve stimulator was done bilaterally on all patients using Bupivacine. A third group complaining of RSD of the ankle, and chronically treated with antidepressant and opoid like drugs were treated with nerve block of the ankle. With the use of a nerve stimulator and ultrasound, the common peroneal nerve at the fi bular neck and the posterior tibial nerve at the distal third of the leg were visualized and blocked. Conclusion: Nerve block in treating chronic pain such as migraine, back pain and refl ex sympathetic dystrophy have shown its effi ciency, and follow up of this patient showed a improvement of their pain and we notice an important decrease in their use of their drugs and opioid like pain killer. A question is to be asked: is nerve block is the adequate tool to cure addiction on pain killers and opioid like drugs by decreasing or eliminating their pain and providing a better life style free of pain and free of the need of addictive drugs.