By Somayaji Ramamurthy MD, Euleche Alanmanou MD, James N. Rogers MD
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Additional resources for Decision Making in Pain Management, 2nd Edition
It appears that as the technology continues to evolve, greater utilization of this modality for treatment will ensue. Choice of a particular modality is usually based on tissue type and likely diagnosis. For headache and facial pain, CT is best for severe, sudden headaches, trauma, and presumed sinusitis. MRI is a better choice for chronic headache and temporomandibular dysfunction. In chest and abdominal pain, plain radiography is a good initial choice with a lack of finding leading to consideration of echocardiography, ECG, CT, ultrasound, or gastrointestinal contrast examinations for further evaluation.
Will a tourniquet be used? Is anesthesia or analgesia required? What are the potential complications associated with each technique? Would the patient benefit from a long-term regional technique such as a peripheral nerve catheter? Finally, what is your experience and expertise? It may be difficult to determine which nerves are involved with the production of pain in an injured or painful extremity. The cutaneous innervation of an extremity is highly variable, with much overlap of adjacent nerves (Figure 1).
Nerve blocks with local anesthetics in high concentration interrupt both afferent and efferent neural conduction; in contrast, with low concentrations of local anesthetics this interruption might become selective. Thus neural conduction in small fibers (A-δ) and nonmyelinated nerve fibers (C fibers) may be interrupted, whereas there is only a modest effect on large myelinated fibers, which are predominantly motor or proprioceptive agents. The limitations of a diagnostic nerve block should be kept in mind because these blocks are simply useful additions to the available diagnostic and prognostic tools.
Decision Making in Pain Management, 2nd Edition by Somayaji Ramamurthy MD, Euleche Alanmanou MD, James N. Rogers MD