morphine / Ganglion blocks

[Diter]

The most irritating thing is the eyepain, to me at least. If you are a rheumy-patient, and with some other diseases that causes pain, the pain itself will be treated also. I was wondering if there are people that get drops / systemic drugs to control eyepain?

Greetings

Chandler

[neil0502]

[I'm new around here]

I have a combination of severe dry eyes (w/4x punctal cautery), accommodative spasm, binocular dysfunction, and some other stuff.

The local Pain Clinic put me on Neurontin and Vicodin, pushing the Neurontin to 2,700mg. At that level, I got very sick. That was June and I'm still not better. Leaving for a nationally-famous clinic in a few weeks to see what happened.

Off the Neurontin, I now take 30 or 60mg of codeine sulfate a couple times a day (6hr intervals). If I take 60, it makes a pretty good difference in the pain, but leaves me dopey--certainly not what I'm looking for, but ... when you need ... you need.

Best of luck!

Neil

[elaine]

something for pain?

It didn't occur to me that they could give me something for pain. I had asked the opthomologist about numbing eye drops but she said they cause eye damage. My eyes hurt all the time and lead me to head aches from excessive blinking. I wonder if I should try a pain clinic. I've always thought of those for people with back pain or migraines....
Thanks,
Elaine

[neil0502]

It didn't occur to me that they could give me something for pain. I had asked the opthomologist about numbing eye drops but she said they cause eye damage. My eyes hurt all the time and lead me to head aches from excessive blinking. I wonder if I should try a pain clinic. I've always thought of those for people with back pain or migraines....
Thanks,
Elaine

Elaine-

This is definitely one of those "your mileage may vary" things. My primary pain-producing diagnosis is this ciliary spasm issue. It's equivalent to charley horses in the focusing muscles of the eyes. That's more than half the source of my pain. The severe dry eye is just kind of the awful icing on the bitter cake. Add the binocular dysfunction and a few more ICD-9 codes in there and you have a genuine mess

Nonetheless, I fought this battle for twenty years before making my first pain clinic appointment. These appointments almost universally require a referral from a treating physician, so that's likely where you'd have to start. It's also a bit of a crap shoot as to what they try to do for you, whether it works at all, and what the side effects are.

Example: the anesthesiologist at the pain clinic recommended a procedure called a "sphenopalatine ganglion block." It seemed simple enough, so we tried it. A few days later, my eyes were even [b]drier[/i]. It was awful. This was late March. They're still not back to the pre- procedure levels (according to Schirmer's and T-BUT testing).

Through some research, I found an article that clearly indicates that this anesthetic procedure also deadens the nerve that triggers tear production. It stopped me from making tears [1]

Yikes.

I am a true believer that we should research everything thoroughly (I missed this one), and be open-minded enough to try anything that's far more likely to help us than to hurt us. For me, though, that usually leaves prescription meds last on the list. It's so much art; so little science. Side effects can be brutal. You'll, obviously, have to make some important decisions if/once you go down that road. When I take enough of the codeine to take the edge off the pain, I definitely "lose a step" in cognitive functioning. It's kind of a three-drink buzz, if you know what I mean. I'm not really fond of it.

I wish you (all) well....

[1]http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

[Rebecca Petris]

Example: the anesthesiologist at the pain clinic recommended a procedure called a "sphenopalatine ganglion block."

Oh my goodness. I am so sorry it went awry for you so badly. But I'm also very glad you brought it up. I've spoken a couple of times on the phone this week with a patient who did the ganglion block and actually was very pleased with the results so I have been meaning to try to learn more about it. Hearing such opposite results is sobering, though.

[neil0502]

Oh my goodness. I am so sorry it went awry for you so badly. But I'm also very glad you brought it up. I've spoken a couple of times on the phone this week with a patient who did the ganglion block and actually was very pleased with the results so I have been meaning to try to learn more about it. Hearing such opposite results is sobering, though.

I wish it were as simple as I made it sound, Rebecca. I mentioned in another post that I was also given high-dose Neurontin which led to a whole host of health problems. I can't be certain which thing led to what problems. I only know that I found that PubMed cite after the fact ... and it scared me.

Was this person using the ganglion block to treat dry eye pain? If so, I'm heartened to hear that it's working well....

[Geri]

Stellate Ganglion Block

I am the person Rebecca wrote about. I have recently had the Stellate Ganglion Block. They can not do both sides of the face at one time. The day after the second one was the best day I have had in 9 months. My eyes are still dry, irritated and burn but the agonizing pain is so much better I can't begin to tell you. I will go next week to have a second one done on my right eye. I finally have some hope. Rebecca asked me to write about this anyway to let you all know that so far it is working. I will post more about this later.

[neil0502]

I am the person Rebecca wrote about. I have recently had the Stellate Ganglion Block. They can not do both sides of the face at one time. The day after the second one was the best day I have had in 9 months. My eyes are still dry, irritated and burn but the agonizing pain is so much better I can't begin to tell you. I will go next week to have a second one done on my right eye. I finally have some hope. Rebecca asked me to write about this anyway to let you all know that so far it is working. I will post more about this later.

I'm soooo happy for you, Geri. I had never heard of the "stellate" ganglion block [1]. Mine was a "sphenopalatine" ganglion block -- they put 4% Lidocaine on long swabs and stick them (far) up my nostrils, leaving them there for about 20 minutes, then wet some new swabs and repeat.

As happy as I am for you, I think I just got sadder for me . What you say seems to indicate that there was an alternate procedure, with good possibile outcomes, and without the side effect of tear cessation. I may have to speak to the anesthesiologist about this one (yes: we always have to educate our doc's ).

It also sounds like the Stellate requires regular injections [2]. Is this your understanding, too? If so, how often are you supposed to receive them?

If I could shed a tear of happiness for your success ... believe me, I would. May the right eye go as well as the left eye, and may your dry eye pain be but a distant memory....


[1] http://depts.washington.edu/anesth/regional/sgtext.html
[2] http://www.reddinganesthesia.com/SGB%20FAQs.htm

[Geri]

Stellate Ganglion Block

Hi Neil. I had both sides done. Three weeks apart. The first one, my right eye I felt relief almost right away. I was really able to tell because the left eye was still in pain. I had very minor side effects from the first one. When my left eye was done I had many side effects. But they are not bad because it means it is really working. I did not get relief from the pain for almost five hours. It actually felt a little worse. I could not talk or swallow food for the five hours. The doctor did hit a blood vessel the first try. It caused the injection site to be very tender. Like a bad bruise. The next morning I woke up and could not believe how good I felt. The right eye (first one) felt like the pain was back though not anywhere near before. My pain doctor told me it is not unusual to have as many as 3-4 blocks in both eyes. My next block will be Nov.1st. Like I said before I do still have irritation, burning along with red eyes and a lot of excess tears. I as well as all of us is still looking forward to the day a cure comes about.