Abstract PR314

Abstract

Background & Objectives: Chronic non-malignant neuropathic pain management is a major challenge for the clinicians despite a wide range of analgesics and pain treatment protocols. First, second, and third line drug treatments for neuropathic pain include the use of anticonvulsants, tricyclic antidepressants, mixed serotonin and norepinephrine reuptake inhibitors, opioids and other various treatment opportunities. However, the results of these treatment protocols for neuropathic pain management are heterogeneous and sometimes with short term outcomes. Although nerve blocks have been recognized as a major modality in chronic pain management, they are not included in guidelines for chronic non-malignant neuropathic pain management. The aim of our study was to investigate whether administration of peripheral nerve blocks with local anesthetic and corticosteroid significantly reduced pain in patients with chronic non-malignant neuropathic pain resistant to standard treatment, based on guidelines for chronic neuropathic pain management. Materials & Methods: 55 patients with chronic non-malignant neuropathic pain that was resistant to standard treatment based on guidelines for neuropathic pain were included in our study. The mixture of local anesthetic (0.125% levobupivacaine) and corticosteroid (betamethasone) was used to perform the blocks of peripheral nerves. Pain was assessed by the use of numeric pain rating scale (NPRS), with range 0-10 (0-no pain to 10-worst possible pain). Pain was evaluated before the application of peripheral nerve blocks and 3 weeks after. Differences between groups of patients were assessed by Wilcoxon signed rank test. All P-values were two-sided and statistical significance (p) was set at a value of 0.01. Results: A Wilcoxon signed rank test revealed a statistically significant reduction in pain, assessed on NPRS, following administration of peripheral nerve blocks, z= –6.47, p< 0.01, with a large effect size (r= 0.62). The median score on NPRS decreased from pre-peripheral nerve block administration (Median= 9; interquartile range (8-10)) to post-peripheral nerve block administration (Median= 3; interquartile range (2-5)). Conclusion: Our results suggest that peripheral nerve blocks improve pain management in patients with chronic non-malignant neuropathic pain and that these interventions could be used as therapeutic approach for patients with neuropathic pain resistant to other treatment alternatives.