Immediate alleviation of chronic pain by bone drilling and probable involvement of bone tissue in pain sensitisation

Abstract

Three patients presented with severe spontaneous pain, allodynia and numbness on the lateral side of the left heal, foot and/or toe due to L5 and/or S1 root injury, as a result of repeated failed back surgeries including Love's surgery and laminaectomy (failed back surgery syndrome). The neuropathic pain in the lower extremities did not respond to somatic nerve block, lumbar-sympathetic ganglion block, spinal cord stimulation, and/or medications. At the spots in the foot showing the most severe allodynia, bones were drilled with fl uoroscopic assistance. Spontaneous pain diminished immediately and allodynia was completely resolved. Visual analogue scale score decreased immediately after bone drilling. The analgesic effect was maintained for 30-45 weeks. In three patients, drilling until the marrow cavity of the bones at painful sites effectively relieved chronic neuropathic pain with lasting analgesic effect.

Pain Relief by Bone Drilling and Osseous Pain Sensitization: A Hypothesis

“…Most authors have ever considered that arthralgia and backache are caused by intramedullary hypertension, and pain relief after BD is brought about by intramedullary decompression [1][2][3][4][5][6][7]. IP was measured by some investigators.…”

“…For arthralgia, one side or both sides of juxta-bones is drilled [4]. In complex regional pain syndrome (CRPS), multiple tender points are selected for the targets of BD [6].…”

“…Thereafter, BD has been considered to be one of the important treatments for pain, and the indication of BD has been extended to various pains including neuropathic pain in Japan [6]. The simple method, immediate onset, long-lasting effect, and harmlessness are the appreciable characteristics [1][2][3][4][5][6][7]. The effect becomes evident immediately after BD, and develops further for a few days.…”

“…Thereafter steady pain relief is obtained [7]. The effect lasts for several months [6] or a few years [7].…”

“…Effectiveness of BD is shown in backache due to VCF [3,5,7,8] and vertebral spondylosis [7,8], arthralgia due to OA of the knee, hip and shoulder [1,4,8] as well as osteonecrosis of the hip [2,8], and neuropathic pain [6]. In acute pain due to VCF, BD is more effective [7].…”