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409 THE EFFECT OF SPINAL CORD STIMULATION (SCS) ON SENSORY CHANGES IN NEUROPATHIC PAIN
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Posters / European Journal of Pain Supplements 4 (2010) 47–146
406 EFFICACY OF CHEMICAL ADHESIOLYSIS IN PATIENTS SUFFERING FROM LOW BACK AND LOW EXTREMITY PAIN: A RETROGRADE ANALYSIS I. Kouroukli, P. Zavridis, T. Kypraiou, M. Hatzis, I. Makri, V. Panaretou. Anesthesiology and Pain Clinic, Hippokratio Hospital of Athens, Athens, Greece Introduction: Epidural adhesiolysis is an interventional pain management technique which plays an active role in managing chronic intractable low back and low extremity pain. Objectives: This study was designed to evaluate the efficacy of chemical adhesiolysis after Racz’s catheter placement in patients with low back and low extremity pain. Methods: 30 patients with low back and low extremity pain were enrolled. All patients suffered from pain for up to 5 months nonresponsive to conservative modalities of management. Patients received chemical adhesiolysis. Hyalase 1500 I.U., Ropivacaine 0.2% and long acting corticosteroids with hypertonic NaCl were administered. Some patients received a combination of trigger points (Tps) infiltration and transforaminal epidural steroids injections before or after chemical adhesiolysis. Pain score a) at first visit b) 6 months after the end of therapy. Results: Twenty-seven patients were included in the statistical analysis. Nineteen underwent a surgical procedure before catheter placement. Twenty-four had a magnetic resonance image before begining of treatment. For the rest epidurogram was used for diagnosis. Interventional techniques such as Tps or transforaminal epidural steroids injection were performed in seven patients before catheter insertion while in other seven were performed after adhesiolysis. In seven patients interventional procedures were performed both before and after adhesiolysis and in six neither before nor after. Fifteen patients had an 80% reduction of pain where 7 had an 40% and 3 had no improvement. Two had transient improvement. Conclusions: Chemical adhesiolysis as the only treatment or in a combination with Tps and transforaminal epidural steroid injections results in reduction of pain in patients with low back and lower extemity pain. 407 ELECTRICAL STIMULATION FOR NEUROPATHIC ABDOMINAL PAIN L. Halley1 , C. Lahr1 , C. Subramony2 , K. Adams3 , D. Spree4 , T. Abell1 . 1 Surgery, 2 Pathology, University of Mississippi, 3 University of Mississippi Medical Center, 4 Medicine, University of Mississippi Medical Center, Jackson, MS, USA Introduction: Gastric stimulation, an established treatment for nausea and vomiting, is controversial for pain. We have observed reduced gastric neuronal cell counts in patients with gastroparesis (GP) and severe abdominal pain. Here we evaluate the effects of temporary gastric electrical stimulation (tGES) on pain and other GP symptoms. Methods: 59 gastroparesis patients (6 male, 53 female; age range 17–66; average age 44.8 yrs; 17 with diabetes) with severe abdominal pain underwent tGES. Only patients who rated their baseline pain scores as 3 or 4 on a Likert scale, patient-reported outcomes tool for GP symptoms (range, 0–4; none to very severe) were included in this study. Electrogastrograms and patient GI symptoms ratings were obtained at baseline and during temporary stimulation. At subsequent permanent GES implantation, full thickness gastric biopsies were obtained for all patients, followed by S100 and CD117 staining and quantification of neurons and interstitial cells of Cajal in the inner and outer muscle layers of the stomach. Two tailed, paired t tests of scores before and after GES for GP symptoms were performed Results: Temporary GES significantly reduced patient-reported abdominal pain scores, as well as other symptoms of GP. (See Table) The mean value of S100 cell counts for all 59 patients was 18.7
(inner and outer muscle layers); for autopsy conrols, it was 45.1. (p = 0.002) Symptoms: baseline & with tGES
Abdominal Pain Score Early Satiety Score Distension Score Nausea Score Vomiting Score
Baseline
During tGES
p value of difference
3.6 3.1 3.2 3.4 2.5
1.3 1.4 1.1 1.1 0.4
<0.0001 <0.0001 <0.0001 <0.0001 <0.0001
Conclusion: Temporary GES significantly reduces abdominal pain in a group of GP patients for whom gut neuropathy has been established. 408 COMPARISON BETWEEN TWO PERCUTANEOUS THERAPIES FOR TRIGEMINAL NEURALGIA: RETROGASSERIAN GLYCEROL RHIZOTOMY AND BALLOON COMPRESSION K. Kouzounias1,2 , G. Lind2 , J. Winter2 , B. Linderoth2,3 . 1 Department of Neurosurgery, Athens Naval Hospital, Athens, Greece; 2 Department of Neurosurgery, Karolinska University Hospital, 3 Karolinska Institute, Stockholm, Sweden Objective: The aim of this study is to compare recent outcomes of percutaneous balloon compression (PBC) and retrogasserian glycerol rhizotomy (PGR) at the Karolinska University Hospital in Stockholm, Sweden. Methods: Within a period of five years 66 PBCs, and during the last three years 120 PGRs were performed. The medical records of the patients were retrospectively reviewed and when needed followedup by telephone. The outcome data analyzed statistically were: the initial effect, the duration of effect and complication rates. Results: The rates for immediate pain relief were 87% for the patients treated with PGR and 85% for the patients after PBC. The Kaplan-Meier plots showed very similar courses for both treatments. The probability to maintain complete pain relief after two years was 38% for PGR and 40% for PBC. The effectiveness of glycerol rhizotomy was reduced with repeated procedures. The general rate of complications was 11% for PGR and 23% for PBC and this difference was statistically significant (Chi-square, p = 0.04). Conclusions: Percutaneous retrogasserian glycerol rhizotomy and balloon compression are both effective techniques to control typical trigeminal neuralgia (TN). PGR has advantages in terms of fewer and milder complications and a lighter anesthetic technique, without compromising the analgetic effect. For this reasons we consider PGR as the first option for the treatment of TN in patients who are not suitable candidates for microvascular decompression, while PBC can be reserved for cases in whom the effect of PGR effect has proven to be short or not reproducable. 409 THE EFFECT OF SPINAL CORD STIMULATION (SCS) ON SENSORY CHANGES IN NEUROPATHIC PAIN K. MacIver1 , D. Harmon2 , T. Nurmikko1 . 1 Pain Research Institute, Clinical Sciences, University of Liverpool, Liverpool, UK; 2 Anaesthesia, Mid Western Regional Hospital, Limerick, Ireland Introduction: Successful management of neuropathic pain reduces global pain and tends to attenuate hyperalgesia. Sensory deficits may also improve. We studied the effect of SCS on sensory thresholds and hyperalgesia. Objectives: To measure the effect of SCS on sensory changes in neuropathic pain. Methods: This report comprises two studies. In Study 1, 35 patients with neuropathic pain were referred for trial SCS. Cutaneous detection thresholds for warmth (WT), cold (CT), heat pain (HPT), sharpness (ST) and touch (TT) were assessed before, during and after stimulation. Test sites were chosen within the painful area and at
Posters / European Journal of Pain Supplements 4 (2010) 47–146
the contralateral mirror image site. Low HPT tended to increase and elevated HPT to decrease with SCS. Study 2 was a randomised crossover trial in which 21 patients with neuropathic pain were tested during and after SCS for brush-evoked dynamic mechanical allodynia (DMA), punctate hyperalgesia (PH), temporal summation to brushing (TSB) and punctate stimuli (TSP), within the painful area and at the control site. Results: Study 1: During SCS all sensory thresholds except TT improved (all p < 0.001). There were no changes in control thresholds. WT improvement was associated with pain relief. Study 2: Intensity of DMA (p < 0.001) but not PH (0.01) improved during SCS. TSB (p < 0.001) but not TSP improved. Areas for DMA (0.05) and PH (0.01) were reduced. Conclusions: SCS tends to normalise sensory abnormalities in neuropathic pain. We hypothesise that this results from the combined activation of segmental and descending systems. It is not due to pain distraction as control thresholds did not change. 410 INTRATHECAL PUMP DELIVERY SYSTEM CAN BE USED AS RESERVOIR, FOR INTERMITTENT IV LIDOCAINE FOR THE TREATMENT OF NEUROPATHIC FLANK PAIN P. Mavrocordatos, D. Skouvaklis, M. Colomb, M. Duplan, C. Ancey, F. Rehm. Centre de la Douleur, Clinique Cecil, Lausanne, Switzerland Introduction: We present a case where an intrathecal pump delivery system, usually utilized intrathecally, is used to treat neuropathic pain with intermittent intravenous Lidocaine boluses. Methods: The story started with a severe left pyelonephrititis in a previously healthy woman. Pyelonephrititis was successfully treated but burning flank pain persisted. CT scan showed a cyst on the left kidney. The radiologist injected it with phenol 6%, pain got worse. The patient was referred to us some months later. After all medication has failed and psychosocial assessment performed, a spinal cord stimulator was implanted after successful trial. Unfortunately, electrodes were unstable and we never got longterm pain coverage. Pain was such that we changed the system to an intrathecal pump infusion with intermittent bupivacaine boluses. Pain was controlled but hypotension was not acceptable. Moreover, the patient developed headaches (brain MRI normal). We then removed the intrathecal catheter thinking headaches could be related to treatment. The pump was left in the abdominal pocket. Left thoracic pain returned and unfortunately headaches remained. We then decided to try intermittent IV lidocaine boluses (PCA device). It turned to be extremely efficient on headaches and on low thoracic pain. An intravenous catheter was then implanted linked to the already implanted pump. Intermittent boluses (35 mg) up to 10 times a day were programmed (lidocaine 200 mg/ml inreservoir). 24 months follow-up data are presented. Conclusions: Since, pain has been reduced by 80%, the patient is managing very well, keeping the number of boluses per day as low as 7. 411 SPINAL CORD STIMULATION: EFFECTS ON QUALITY OF LIFE EVALUATED BY THE SF-36 QUESTIONNAIRE K. Meier1,2 , B. Christensen1 , L. Nikolajsen1 , J.-C. Sørensen2 , T. Staehelin Jensen1 . 1 Danish Pain Research Center, 2 Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark Introduction: Spinal cord stimulation is a minimally invasive surgical treatment for chronic neuropathic pain. At Aarhus University Hospital we have used the technique since 2006, and currently 32 patients have been treated, primarily for peripheral pain following direct nerve injury. Objectives: We aimed to assess the effect on quality of life using the SF-36 questionnaire. Methods: Patients scheduled for implantation of a spinal cord stimulation system received an SF-36 form before implantation.
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Follow-up questionnaires were sent out 3–6 months and again 12 months postoperatively. Replies in the 8 domains of the SF-36 were transformed to numerical values and additionally the physical and mental component scores were computed. Results pre- and postoperatively were compared using the Wilcoxon signed-rank test. Results: To date, 13 patients have completed both the preoperative and at least one postoperative questionnaire. The preliminary data show a decrease in pain ratings on a numerical pain rating scale (NRS 0–10) from a mean of 7.2 to 3.9. There was a limited but significant improvement in mental component score with a significant improvement in the mental health and the social function score, and borderline significant improvements in the role emotional and vitality scores. Conclusions: Our preliminary data demonstrated a significant improvement in pain ratings and mental well-being as assessed by the SF-36 quality of life questionnaire. Additional data will be presented at the congress. 412 THE ADVANTAGES OF THE USE OF THE CT SCANNER IN THE INTERVENTIONAL PROCEDURES OF THE NEUROPATHIC PAIN A. Mitrushi1,2 , A. Vaso1 , P. Prifti1 . 1 Faculty of Medicine, University of Tirana, 2 The Clinique “Galenus”, Tirana, Albania Introduction: The micro invasive procedures of the treatment of the pain in the majority of the pain treatment centres thorough the world are performed by means of the fluoroscopic technique. In our practice, we have modified these procedures by replacing above technique, with the application of the CT scanner technique. We have assumed that the modification has some significant advantages. Objectives: The promotion of the application of the CT scanner technique in the micro invasive procedures of the treatment of the neuropathic pain. Methods: Micro invasive procedures of the treatment of the neuropathic pain of 342 cases, performed by our multidisciplinary staff (radiologists, anaesthesiologists, psychologists and physiotherapeutists). Results: The use of the CT scanner in the treatment procedures of the neuropathique pain reveals significant advantages against the traditional methods: 1. Imaging resolution is quite better. 2. The roentgen radiation dosage of the patient and that of the secondary ionized of the manipulator is reduced considerably. 3. Above items enable more careful and stressles manipulations. 4. The modified procedure might increase the number of the collaborators, so that the procedure doesn’t remain in the condition of an individual manipulation. 5. As a consequence: a. The premises of the precision during the procedure are improved; b. The confirmation of the diagnosis among the interested medical staff is facilitated. Conclusions: The professional advantages as well as the patient benefits are more significant than the disadvantage of the higher cost and suggest CT scanner to be used routinely in the treatment procedures of the neuropathique pain. 413 THE EFFECTIVENESS OF CT-GUIDED SELECTIVE SPINAL NERVE ROOT BLOCKS FOR THE TREATMENT OF POSTHERPETIC NEURALGIA J. Park. Nonsurgical Spine Total Care Center, Daegu Wooridul Spine Hospital, Daegu, Republic of Korea Introduction: Postherpetic neuralgia (PHN) is a challenging neuropathic pain syndrome. PHN, defined as a pain persisting more than 3 months after the rash has healed, is debilitating and difficult to manage consequence of herpes zoster. Anticonvulsants, tricyclic antidepressants, opioids, and topical treatment modalities such as
Posters / European Journal of Pain Supplements 4 (2010) 47–146
406 EFFICACY OF CHEMICAL ADHESIOLYSIS IN PATIENTS SUFFERING FROM LOW BACK AND LOW EXTREMITY PAIN: A RETROGRADE ANALYSIS I. Kouroukli, P. Zavridis, T. Kypraiou, M. Hatzis, I. Makri, V. Panaretou. Anesthesiology and Pain Clinic, Hippokratio Hospital of Athens, Athens, Greece Introduction: Epidural adhesiolysis is an interventional pain management technique which plays an active role in managing chronic intractable low back and low extremity pain. Objectives: This study was designed to evaluate the efficacy of chemical adhesiolysis after Racz’s catheter placement in patients with low back and low extremity pain. Methods: 30 patients with low back and low extremity pain were enrolled. All patients suffered from pain for up to 5 months nonresponsive to conservative modalities of management. Patients received chemical adhesiolysis. Hyalase 1500 I.U., Ropivacaine 0.2% and long acting corticosteroids with hypertonic NaCl were administered. Some patients received a combination of trigger points (Tps) infiltration and transforaminal epidural steroids injections before or after chemical adhesiolysis. Pain score a) at first visit b) 6 months after the end of therapy. Results: Twenty-seven patients were included in the statistical analysis. Nineteen underwent a surgical procedure before catheter placement. Twenty-four had a magnetic resonance image before begining of treatment. For the rest epidurogram was used for diagnosis. Interventional techniques such as Tps or transforaminal epidural steroids injection were performed in seven patients before catheter insertion while in other seven were performed after adhesiolysis. In seven patients interventional procedures were performed both before and after adhesiolysis and in six neither before nor after. Fifteen patients had an 80% reduction of pain where 7 had an 40% and 3 had no improvement. Two had transient improvement. Conclusions: Chemical adhesiolysis as the only treatment or in a combination with Tps and transforaminal epidural steroid injections results in reduction of pain in patients with low back and lower extemity pain. 407 ELECTRICAL STIMULATION FOR NEUROPATHIC ABDOMINAL PAIN L. Halley1 , C. Lahr1 , C. Subramony2 , K. Adams3 , D. Spree4 , T. Abell1 . 1 Surgery, 2 Pathology, University of Mississippi, 3 University of Mississippi Medical Center, 4 Medicine, University of Mississippi Medical Center, Jackson, MS, USA Introduction: Gastric stimulation, an established treatment for nausea and vomiting, is controversial for pain. We have observed reduced gastric neuronal cell counts in patients with gastroparesis (GP) and severe abdominal pain. Here we evaluate the effects of temporary gastric electrical stimulation (tGES) on pain and other GP symptoms. Methods: 59 gastroparesis patients (6 male, 53 female; age range 17–66; average age 44.8 yrs; 17 with diabetes) with severe abdominal pain underwent tGES. Only patients who rated their baseline pain scores as 3 or 4 on a Likert scale, patient-reported outcomes tool for GP symptoms (range, 0–4; none to very severe) were included in this study. Electrogastrograms and patient GI symptoms ratings were obtained at baseline and during temporary stimulation. At subsequent permanent GES implantation, full thickness gastric biopsies were obtained for all patients, followed by S100 and CD117 staining and quantification of neurons and interstitial cells of Cajal in the inner and outer muscle layers of the stomach. Two tailed, paired t tests of scores before and after GES for GP symptoms were performed Results: Temporary GES significantly reduced patient-reported abdominal pain scores, as well as other symptoms of GP. (See Table) The mean value of S100 cell counts for all 59 patients was 18.7
(inner and outer muscle layers); for autopsy conrols, it was 45.1. (p = 0.002) Symptoms: baseline & with tGES
Abdominal Pain Score Early Satiety Score Distension Score Nausea Score Vomiting Score
Baseline
During tGES
p value of difference
3.6 3.1 3.2 3.4 2.5
1.3 1.4 1.1 1.1 0.4
<0.0001 <0.0001 <0.0001 <0.0001 <0.0001
Conclusion: Temporary GES significantly reduces abdominal pain in a group of GP patients for whom gut neuropathy has been established. 408 COMPARISON BETWEEN TWO PERCUTANEOUS THERAPIES FOR TRIGEMINAL NEURALGIA: RETROGASSERIAN GLYCEROL RHIZOTOMY AND BALLOON COMPRESSION K. Kouzounias1,2 , G. Lind2 , J. Winter2 , B. Linderoth2,3 . 1 Department of Neurosurgery, Athens Naval Hospital, Athens, Greece; 2 Department of Neurosurgery, Karolinska University Hospital, 3 Karolinska Institute, Stockholm, Sweden Objective: The aim of this study is to compare recent outcomes of percutaneous balloon compression (PBC) and retrogasserian glycerol rhizotomy (PGR) at the Karolinska University Hospital in Stockholm, Sweden. Methods: Within a period of five years 66 PBCs, and during the last three years 120 PGRs were performed. The medical records of the patients were retrospectively reviewed and when needed followedup by telephone. The outcome data analyzed statistically were: the initial effect, the duration of effect and complication rates. Results: The rates for immediate pain relief were 87% for the patients treated with PGR and 85% for the patients after PBC. The Kaplan-Meier plots showed very similar courses for both treatments. The probability to maintain complete pain relief after two years was 38% for PGR and 40% for PBC. The effectiveness of glycerol rhizotomy was reduced with repeated procedures. The general rate of complications was 11% for PGR and 23% for PBC and this difference was statistically significant (Chi-square, p = 0.04). Conclusions: Percutaneous retrogasserian glycerol rhizotomy and balloon compression are both effective techniques to control typical trigeminal neuralgia (TN). PGR has advantages in terms of fewer and milder complications and a lighter anesthetic technique, without compromising the analgetic effect. For this reasons we consider PGR as the first option for the treatment of TN in patients who are not suitable candidates for microvascular decompression, while PBC can be reserved for cases in whom the effect of PGR effect has proven to be short or not reproducable. 409 THE EFFECT OF SPINAL CORD STIMULATION (SCS) ON SENSORY CHANGES IN NEUROPATHIC PAIN K. MacIver1 , D. Harmon2 , T. Nurmikko1 . 1 Pain Research Institute, Clinical Sciences, University of Liverpool, Liverpool, UK; 2 Anaesthesia, Mid Western Regional Hospital, Limerick, Ireland Introduction: Successful management of neuropathic pain reduces global pain and tends to attenuate hyperalgesia. Sensory deficits may also improve. We studied the effect of SCS on sensory thresholds and hyperalgesia. Objectives: To measure the effect of SCS on sensory changes in neuropathic pain. Methods: This report comprises two studies. In Study 1, 35 patients with neuropathic pain were referred for trial SCS. Cutaneous detection thresholds for warmth (WT), cold (CT), heat pain (HPT), sharpness (ST) and touch (TT) were assessed before, during and after stimulation. Test sites were chosen within the painful area and at
Posters / European Journal of Pain Supplements 4 (2010) 47–146
the contralateral mirror image site. Low HPT tended to increase and elevated HPT to decrease with SCS. Study 2 was a randomised crossover trial in which 21 patients with neuropathic pain were tested during and after SCS for brush-evoked dynamic mechanical allodynia (DMA), punctate hyperalgesia (PH), temporal summation to brushing (TSB) and punctate stimuli (TSP), within the painful area and at the control site. Results: Study 1: During SCS all sensory thresholds except TT improved (all p < 0.001). There were no changes in control thresholds. WT improvement was associated with pain relief. Study 2: Intensity of DMA (p < 0.001) but not PH (0.01) improved during SCS. TSB (p < 0.001) but not TSP improved. Areas for DMA (0.05) and PH (0.01) were reduced. Conclusions: SCS tends to normalise sensory abnormalities in neuropathic pain. We hypothesise that this results from the combined activation of segmental and descending systems. It is not due to pain distraction as control thresholds did not change. 410 INTRATHECAL PUMP DELIVERY SYSTEM CAN BE USED AS RESERVOIR, FOR INTERMITTENT IV LIDOCAINE FOR THE TREATMENT OF NEUROPATHIC FLANK PAIN P. Mavrocordatos, D. Skouvaklis, M. Colomb, M. Duplan, C. Ancey, F. Rehm. Centre de la Douleur, Clinique Cecil, Lausanne, Switzerland Introduction: We present a case where an intrathecal pump delivery system, usually utilized intrathecally, is used to treat neuropathic pain with intermittent intravenous Lidocaine boluses. Methods: The story started with a severe left pyelonephrititis in a previously healthy woman. Pyelonephrititis was successfully treated but burning flank pain persisted. CT scan showed a cyst on the left kidney. The radiologist injected it with phenol 6%, pain got worse. The patient was referred to us some months later. After all medication has failed and psychosocial assessment performed, a spinal cord stimulator was implanted after successful trial. Unfortunately, electrodes were unstable and we never got longterm pain coverage. Pain was such that we changed the system to an intrathecal pump infusion with intermittent bupivacaine boluses. Pain was controlled but hypotension was not acceptable. Moreover, the patient developed headaches (brain MRI normal). We then removed the intrathecal catheter thinking headaches could be related to treatment. The pump was left in the abdominal pocket. Left thoracic pain returned and unfortunately headaches remained. We then decided to try intermittent IV lidocaine boluses (PCA device). It turned to be extremely efficient on headaches and on low thoracic pain. An intravenous catheter was then implanted linked to the already implanted pump. Intermittent boluses (35 mg) up to 10 times a day were programmed (lidocaine 200 mg/ml inreservoir). 24 months follow-up data are presented. Conclusions: Since, pain has been reduced by 80%, the patient is managing very well, keeping the number of boluses per day as low as 7. 411 SPINAL CORD STIMULATION: EFFECTS ON QUALITY OF LIFE EVALUATED BY THE SF-36 QUESTIONNAIRE K. Meier1,2 , B. Christensen1 , L. Nikolajsen1 , J.-C. Sørensen2 , T. Staehelin Jensen1 . 1 Danish Pain Research Center, 2 Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark Introduction: Spinal cord stimulation is a minimally invasive surgical treatment for chronic neuropathic pain. At Aarhus University Hospital we have used the technique since 2006, and currently 32 patients have been treated, primarily for peripheral pain following direct nerve injury. Objectives: We aimed to assess the effect on quality of life using the SF-36 questionnaire. Methods: Patients scheduled for implantation of a spinal cord stimulation system received an SF-36 form before implantation.
117
Follow-up questionnaires were sent out 3–6 months and again 12 months postoperatively. Replies in the 8 domains of the SF-36 were transformed to numerical values and additionally the physical and mental component scores were computed. Results pre- and postoperatively were compared using the Wilcoxon signed-rank test. Results: To date, 13 patients have completed both the preoperative and at least one postoperative questionnaire. The preliminary data show a decrease in pain ratings on a numerical pain rating scale (NRS 0–10) from a mean of 7.2 to 3.9. There was a limited but significant improvement in mental component score with a significant improvement in the mental health and the social function score, and borderline significant improvements in the role emotional and vitality scores. Conclusions: Our preliminary data demonstrated a significant improvement in pain ratings and mental well-being as assessed by the SF-36 quality of life questionnaire. Additional data will be presented at the congress. 412 THE ADVANTAGES OF THE USE OF THE CT SCANNER IN THE INTERVENTIONAL PROCEDURES OF THE NEUROPATHIC PAIN A. Mitrushi1,2 , A. Vaso1 , P. Prifti1 . 1 Faculty of Medicine, University of Tirana, 2 The Clinique “Galenus”, Tirana, Albania Introduction: The micro invasive procedures of the treatment of the pain in the majority of the pain treatment centres thorough the world are performed by means of the fluoroscopic technique. In our practice, we have modified these procedures by replacing above technique, with the application of the CT scanner technique. We have assumed that the modification has some significant advantages. Objectives: The promotion of the application of the CT scanner technique in the micro invasive procedures of the treatment of the neuropathic pain. Methods: Micro invasive procedures of the treatment of the neuropathic pain of 342 cases, performed by our multidisciplinary staff (radiologists, anaesthesiologists, psychologists and physiotherapeutists). Results: The use of the CT scanner in the treatment procedures of the neuropathique pain reveals significant advantages against the traditional methods: 1. Imaging resolution is quite better. 2. The roentgen radiation dosage of the patient and that of the secondary ionized of the manipulator is reduced considerably. 3. Above items enable more careful and stressles manipulations. 4. The modified procedure might increase the number of the collaborators, so that the procedure doesn’t remain in the condition of an individual manipulation. 5. As a consequence: a. The premises of the precision during the procedure are improved; b. The confirmation of the diagnosis among the interested medical staff is facilitated. Conclusions: The professional advantages as well as the patient benefits are more significant than the disadvantage of the higher cost and suggest CT scanner to be used routinely in the treatment procedures of the neuropathique pain. 413 THE EFFECTIVENESS OF CT-GUIDED SELECTIVE SPINAL NERVE ROOT BLOCKS FOR THE TREATMENT OF POSTHERPETIC NEURALGIA J. Park. Nonsurgical Spine Total Care Center, Daegu Wooridul Spine Hospital, Daegu, Republic of Korea Introduction: Postherpetic neuralgia (PHN) is a challenging neuropathic pain syndrome. PHN, defined as a pain persisting more than 3 months after the rash has healed, is debilitating and difficult to manage consequence of herpes zoster. Anticonvulsants, tricyclic antidepressants, opioids, and topical treatment modalities such as