Procedure uses phenol, Botox to alleviate pain

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GwinnettDailyPost, originally uploaded by rsdscrpsnews.

Procedure uses phenol, Botox to alleviate pain

11/15/2005

By John Davis
Morris News Service

LUBBOCK, Texas — About two minutes after the injection, her hand could move again.

The pain was gone.

A big smile crossed 38-year-old Noreen Pfund’s face as she opened and closed her hand, then put her arm above her head.
“Oh my gosh,” she said as she lay on a table in an operating room at University Medical Center.

These may seem like simple tasks, but pain caused by reflex sympathetic dystrophy stopped the Phoenix real estate agent from performing them and ended her career as a golf professional.
Chronic neurological syndrome is also known as complex regional pain syndrome. Patients experience severe burning pain, tissue swelling and extreme sensitivity to touch, according to rsds.org.
Stopping the pain stumped doctors at the Mayo Clinic in Scottsdale, Ariz., Pfund said, and they suggested she come to Lubbock for treatment Sept. 27.

After receiving a treatment developed by Dr. Gabor Racz, Pfund can swing her golf clubs again.

“It is amazing,” Pfund said. “I’ve had a number of procedures over the past eight years. His are the only ones that work. He uses a certain medicine that other doctors are not willing to do.”
Nine years ago, when she was 29, Pfund came down with a bad case of influenza.

For some reason, the flu caused pain in her joints and pain that doctors originally diagnosed as fibromyalgia. Reflex sympathetic dystrophy usually is caused by injuries, she said.
Her active lifestyle came to a screeching halt.

“It was tough,” Pfund said. “I couldn’t drive. I couldn’t do anything. I would go in to a doctor I had here every Tuesday and Thursday, and he would give me (nerve) blocks, but it was just temporary. It would give me relief for eight or 10 hours. The doctor I had finally gave up on me.”

Golf was Pfund’s passion, and she was told she’d never do it again. She’d never get the strength back in her hand. She’d never lift a coffee cup again.

“I’m doing all of that,” she said.

Weeks after her trip to Lubbock for the nerve block procedure, in which medications are injected into or around a nerve to block pain, Pfund hit the links and shot an 82.

Her Lubbock doctor is professor emeritus of the anesthesiology department and director at the International Pain Institute at Texas Tech University Health Sciences Center. Racz said he performed a procedure called a long-lasting stellate ganglion block.
He injected Botox, a chemical used to relax muscles, to allow Pfund’s hand to move, he said. Her disease had caused the muscles in her hand to contract.

He used a 2.8 percent solution of phenol — a caustic chemical commonly used for preserving cadavers. Phenol kills nerve cells that send unnecessary pain signals to the brain, he said.

About 25 years ago, Racz said, he discovered that a 2.8 percent solution delivered to the site of the seventh cervical vertebrae can help end pain in the face, neck and arm when medicines didn’t work.

Prior to this, doctors would deliver the nerve block to the a site near the sixth cervical vertebrae, which isn’t as effective, Racz said.

Racz said relief lasts months, years or a lifetime.

Prior to this, doctors would deliver the nerve block to the sixth cervical vertebrae, which isn’t as effective, Racz said.
Then came pulse radio frequency, where radio waves are used to heat but not kill nerves sending pain signals, he said.

Though safer than phenol, Medicare and insurance companies declared the radio procedure as investigational, Racz said, and would no longer pay for it.

However, through practice, he produced more favorable outcomes using the phenol treatment than with the pulse radio frequency.
He uses fluoroscopic X-ray to guide the needle during the procedure so that the needle doesn’t go into the esophagus or hit an artery.

“It is not a procedure that should be attempted by anybody who is not trained in the specific technique,” Racz said. “It’s kind of like taking a hammer and hitting a diamond. In the hand of a diamond specialist it works, but someone else may pulverize it.”

Racz said the 2.8 percent solution of phenol in the nerve block seems to be the right concentration to give months of relief. Many patients can live pain-free lives after the procedure is performed.
Dr. Rinoo Shah, an assistant professor in the pain division of TTUHSC’s department of anesthesiology and co-director of pain services, also has been trained to perform the procedure.

Though using nerve blocks to stop pain has been around since the early to mid-1900s, he said, many physicians prefer to use medications rather than perform risky procedures.

He said the new technique can put an end to the constant pain for patients with reflex sympathetic dystrophy syndrome because medications don’t help stop the pain.

“In the proper hands, this is an effective tool that can be done safely,” Shah said.

The procedure is not without risks, Shah said. If done incorrectly, doctors could interrupt blood supply to the brain or risk the needle going into the esophagus or the spinal chord where a nerve could get damaged.

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