The efficacy of neurolytic coeliac plexus block (NCPB) guided by computerized tomography (CT) was compared with pharmacological therapy in the treatment of pain due to pancreatic cancer. The study involved 56 patients who were placed randomly in either a NCPB group and pharmacological therapy group. At day 1, 7, and 14, the visual analogue scale (VAS) pain scores of the NCPB group were significantly lower than those of the pharmacological therapy group (P < 0.01), with values of 1.3 +/- 0.8 versus 4.1 +/- 0.9, 1.7 +/- 1.1 versus 3.1 +/- 1.1, and 2.0 +/- 1.1 versus 2.9 +/- 0.6, respectively. However, the differences in the improvement of quality of life (QOL) between two groups were not statistically significant. Moreover, the dose of opioid was significantly lower in the patients of group 1 than those of group 2, while the complications related to NCPB were transient. We therefore concludes that CT-guided NCPB with alcohol is an effective and safe modality in the management of intractable pancreatic cancer pain.

The results suggest that rTMS is an effective and safe therapy in patients with PHN.

To evaluate the efficacy of computed tomography (CT) guided single radiofrequency thermocoagualtion (RFT) in 1137 patients with idiopathic trigeminal neuralgia after a follow-up period of 11 years, specially focused on duration of pain relief in different branches of trigeminal nerve, side effect, and complications.Retrospective study of patients with idiopathic trigeminal neuralgia treated with a single CT guided RFT procedure between January 2002 and December 2013.The mean follow-up time was 46.14 ± 30.91 months. Immediate postprocedure pain relief was 98.4%. V2 division obtained the best pain relief rate: 91%, 89%, 80%, 72%, 60%, and 54% at 1, 3, 5, 7, 9, and 11 years, respectively. No statistical difference pairwise comparison was in other groups. The complications included masseter muscle weakness, corneitis, diplopia, ptosis, hearing loss, limited mouth opening, and low pressure headache. Masticatory weakness mostly occurred in patients with V3 branch involvement, while Corneitis and Diplopia all in patients with V1 branch involvement. No mortalities observed during or after RFT.All different branches division of trigeminal neuralgia achieved comparable satisfactory curative effect; V2 obtained the best excellent pain relief, after RFT procedure. Facial numbness is inevitable after RFT, which patients who have pain in all 3 trigeminal divisions and patients who desire no facial numbness should be cautious. Masticatory weakness is mainly related with V3 injured, while Corneitis and Diplopia in patients with V1 injured by RFT.

The incidence of trigeminal neuralgia (TN) in elderly patients is higher. However, for those with poor fitness, the optimal surgical treatment for those refractory to medical treatment is controversial. The aim of current study was to investigate the long-term outcome of computed tomography (CT)-guided percutaneous radiofrequency thermocoagulation (PRT) for 304 TN patients 70 years or older. We conducted a retrospective study of 304 elderly patients with TN who were treated with CT-guided PRT between 2002 and 2012. Follow-up was censored at the time of last contact, additional surgery, or death. Sixty-seven patients (22.1%) were of more than American Society of Anesthesiologists classification system physical status II. Excellent pain relief was 100% at discharge, 85% at 1 year, 75% at 3 years, 71% at 5 years, and 49% at 10 years. Pain relief outcomes were correlated with facial numbness. Lower temperature group (≤75°C) can attain the same long-term pain relief as higher temperature group (≥80°C); however, the incidence of painful dysesthesia rate of higher temperature group was higher than lower temperature group. Postoperative morbidity included facial numbness, masseter weakness, corneitis, hearing loss, dropping eyelid, and limited mouth opening. There were no mortalities observed during or after PRT. Our result showed CT-guided PRT is safe and effective for classic TN patients 70 years or older, including poor-fitness patients (American Society of Anesthesiologists classification system physical status >II). Lower temperature (≤75°C) is recommended for PRT in the treatment of TN.