Although complex regional pain syndrome has been a recognized entity for over 100 years, no clear evidence exists for first-line treatments; however, new technologies that are applicable in complex regional pain syndrome treatment have been developed.

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Localized neuropathic pain (LNP) is of peripheral origin and is characterized by circumscribed areas of pain with abnormal skin sensitivity or spontaneous symptoms that are characteristic of neuropathic pain, e.g., burning pain. It should be noted that LNP is confined to a specific area no larger than a letter size sheet of paper. LNP accounts for 60 % of neuropathic pain syndromes. There is no single etiology of LNP. The diagnostic approach is similar to that for other neuropathic pain conditions. General diagnostic tools are used to assess clinical features. So far, there are no specific guidelines for the management of LNP; for this reason, guidelines for general neuropathic pain are used. Topical treatments are included as part of second-line strategies in the Canadian Pain Society guidelines. Despite the lack of guidelines, 5 % lidocaine patches and 8 % capsaicin patches have been proven effective in LNP models.

Background: The Gasserian ganglion is a well-known target for facial pain management, and patients with cancer present an anatomical challenge owing to tumor progression or treatment itself. Computed tomography (CT) is an alternative method for guiding these procedures.Methods: This was an observational retrospective analysis of patients with cancer-related facial pain who underwent CT-guided Gasserian ganglion interventions using local anesthetics, local anesthetics with steroids, phenol, and radiofrequency. Demographic, clinical, and procedure-related variables were collected from January 1, 2015, to December 30, 2018, at the National Cancer Institute. Data distribution was determined using the Kolmogorov–Smirnov test. A paired sample t-test (with a cut-off of P < 0.05 for statistical significance) was used for comparing outcome.Results: We observed a significant reduction in numerical rating scale (NRS) and douleur neuropathique 4 (DN4) scores from 7.6 ± 1.4 and 4.4 ± 1.4 to 3.2 ± 2.0 and 2.2 ± 1.4 points, respectively (P < 0.001). After the procedure, 70.8% of the patients were satisfied; 16.7% were very satisfied, and 12.5% were unsatisfied. No intra- or postoperative complications were observed. The most common neoplasms were head and neck tumors (83.3%).Conclusions: Our data suggest that CT guidance is an effective and safe option for managing cancer-related facial pain in patients with complex anatomy, resulting in a significant reduction in pain, high satisfaction rates, and no mechanical complications. Future research should aim to refine the role of CT guidance in multimodal pain management in this population.

El dolor neuropático localizado (DNL) es de origen periférico y se caracteriza por áreas circunscritas de dolor con sensibilidad anormal de la piel o síntomas espontáneos característicos de dolor neuropático, por ejemplo, dolor urente. Se debe resaltar que el DNL está confinado a un área específica no mayor a una hoja de papel tamaño carta. El DNL representa 60 % de las condiciones de dolor neuropático. No existe una única etiología. El abordaje diagnóstico es similar al de otros síndromes dolorosos neuropáticos. Se utilizan herramientas diagnósticas generales para evaluar las características clínicas. En la actualidad no existen guías específicas de manejo del DNL, por lo que se utilizan las guías para dolor neuropático en general. En las guías de la Sociedad Canadiense de Dolor se incluyen los tratamientos tópicos como parte de las estrategias de segunda línea. Pese a la falta de guías, los parches de lidocaína a 5 % y los parches de capsaicina a 8 % han demostrado ser efectivos en modelos de DNL.