Objective. Current recommendations controversially discuss local infiltration techniques as specific treatment for refractory pain syndromes. Evidence of effectiveness remains inconclusive and local infiltration series are discussed as a therapeutic option in patients not responding to standard therapy. The aim of this study was to investigate the effectiveness of infiltration series with techniques such as sphenopalatine ganglion (SPG) block and ganglionic local opioid analgesia (GLOA) for the treatment of neuropathic pain in the head and neck area in a selected patient group. Methods. In a retrospective clinical study, 4960 cases presenting to our university hospital outpatient pain clinic between 2009 and 2016 were screened. Altogether, 83 patients with neuropathic pain syndromes receiving local infiltration series were included. Numeric rating scale (NRS) scores before, during, and after infiltration series, comorbidity, and psychological assessment were evaluated. Results. Maximum NRS before infiltration series was median 9 (IQR 8–10). During infiltration series, maximum NRS was reduced by mean 3.2 points (SD 3.3, ) equaling a pain reduction of 41.0% (SD 40.4%). With infiltration series, mean pain reduction of at least 30% or 50% NRS was achieved in 54.2% or 44.6% of cases, respectively. In six percent of patients, increased pain intensity was noted. Initial improvement after the first infiltration was strongly associated with overall improvement throughout the series. Conclusion. This study suggests a beneficial effect of local infiltration series as a treatment option for refractory neuropathic pain syndromes in the context of a multimodal approach. This effect is both significant and clinically relevant and therefore highlights the need for further randomized controlled trials.

中文翻译：

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神经节阻滞和神经阻滞系列作为难治性神经性疼痛慢性疼痛患者治疗选择的回顾性研究。

目标。当前的建议有争议地讨论了局部浸润技术作为难治性疼痛综合征的具体治疗方法。有效性的证据尚无定论，局部渗透系列被讨论为对标准治疗无效的患者的治疗选择。这项研究的目的是研究使用蝶ala神经节（SPG）阻滞和神经节局部阿片类镇痛（GLOA）等技术治疗入渗系列药物在选定患者组中头部和颈部神经痛的疗效。方法。在一项回顾性临床研究中，筛选了2009年至2016年间在我们大学医院门诊疼痛诊所就诊的4960例病例。总共包括83例接受局部浸润系列治疗的神经性疼痛综合征患者。评估渗透系列，合并症和心理评估之前，之中和之后的数字评分量表（NRS）得分。结果。渗透系列之前的最大NRS为中位数9（IQR 8-10）。在渗透过程中，最大NRS平均降低了3.2点（SD 3.3，）减轻了41.0％（标准差40.4％）。使用渗透系列，分别在54.2％或44.6％的病例中平均减轻了至少30％或50％的NRS。在百分之六的患者中，疼痛强度增加。第一次渗透后的初步改善与整个系列的整体改善密切相关。结论。这项研究表明在多模式方法的背景下，局部浸润系列作为难治性神经性疼痛综合征的治疗选择的有益效果。这种作用既重要又具有临床意义，因此突出了对进一步随机对照试验的需求。