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chiatric issue," she notes, "but research has shown that amputa-
tion disrupts the nervous system on the peripheral level and dis-
rupts signals to the spinal cord."
In the July 2014 issue of the journal Pain, a team of Israeli and
Albanian researchers reported on the peripheral nerve origins of
phantom limb sensations (
tinyurl.com/lr29udk
). They concluded
that they are not the result of the loss of sensory input and the
brain's failure to adapt, but instead caused by exaggerated input
from the dorsal root ganglia that once served the limb. In their
experiments, intraforaminal epidural blocks "rapidly and
reversibly extinguished" the phantom pain, while control injec-
tions didn't. "We recommend the [dorsal root ganglia] as a target
for treatment of [phantom limb pain] and perhaps also other
types of regional neuropathic pain," they write.
To locate the nerve root source of shingles' neuralgia or phan-
tom limb pain, physicians can use transcutaneous electrical nerve
stimulation (TENS) units to test out the possibilities, says Ms.
Wrobleski. The external devices, which utilize electrodes tem-
porarily affixed to the skin, are the same technology that's used to
verify surgical plans for implanting subcutaneous nerve stimula-
tors into chronic pain patients. "In each case you're asking, 'Did
you get any relief? For how long?'"
3. Headaches
Headaches are a persistent symptom among patients who suffer
traumatic brain injuries such as concussions. They're challenging
to treat and they run the risk of becoming a chronic condition.
Peripheral nerve blocks administered into the scalp provide a
therapeutic effect not only to adult patients with post-traumatic
headaches, but also to pediatric patients, with safe and effective
R E G I O N A L A N E S T H E S I A
