Sphenopalatine Ganglion Block Relieves Chronic Abdominal Wall Pain!

Abstract

Chronic abdominal wall pain is often difficult to manage with physical/occupational therapy, analgesic medications, and invasive procedures. We report the first case of a transnasal sphenopalatine ganglion block that repeatedly provided greater than 80% pain relief for a patient suffering from intractable chronic abdominal wall pain. A 28-year-old female with Crohn's disease presented with intractable chronic abdominal wall pain after several abdominal surgeries. Imaging did not demonstrate any pathological abnormality. Physical therapy, occupational therapy, pharmacological medications, transcutaneous electrical nerve stimulation, trigger point injections with steroids, transversus abdominis plane block, and surgery provided minimal relief. Considering that sphenopalatine ganglion block has previously relieved pain of various etiologies, we offered it to this patient. Long cotton-tips were soaked in Lidocaine 4% topical solution and were advanced into each nasal sinus until gentle resistance was met and left in place for a total of 15 minutes. This process was repeated two more times, for a total of 45 minutes. After the first SPGB, the patient had 80% pain relief that lasted for 3 weeks, with significant improvement in her daily function. Since then, the patient has been receiving this block monthly, for a total of six times so far. Each time, the patient has been experiencing the same effect, with sometimes even more than 80% pain relief.