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Suboccipital Neuralgia

Anonymous on March 25, 2021 at 6:20 pm
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    • Anonymous

      Is it more effective to treat suboccipital neuralgia with injections or cryo? I have colleagues that do both.

      • Fabricio Dias AssisFabricio Dias Assis
        Joined: Sep 6, 2016
        Posts: 5

        We usually do it in steps. At first we do an injection with local and steroids. If there is just a temporary relief then we go to cryo.

        • Robert RapcanRobert Rapcan
          Joined: Dec 6, 2018
          Posts: 7

          Various studies have investigated interventional techniques for the treatment of occipital neuralgia (ON), including local and steroid infiltrations, with limited duration of benefit. With local anaesthetic and steroid injections, most of the patients experience return of pain within 2 weeks. Just a very limited number of patients have longer duration of analgesia than 2 weeks after LA/steroid injections.Use of botulinum toxin type A has also been studied and shown to provide longer duration than LA/steroid injections, with a mean duration of pain relief for 4 months . Pulsed radiofrequency ablation has been studied and has shown some promising results, with benefit in the majority of patients for 6 months. Very few studies have been performed on the topic of cryoanalgesia and ON. Our experience shows that cryoanalgesia provides significant pain relief for those who receive benefit (> 50%) with local anesthetic blocks for no longer than 2 weeks. Duration of pain relief after correctly performed cryoanalgesia is around 6 months with the possibility to repeat the procedure when needed.

            • Anonymous

              Dr. Rapcan,

              Thank you for your informative answer. You stated that both pulsed RF and Cryo have proven, long term benefits. Do you personally have a preference…given that both are not commonly covered (cash pay)?

              Thank you!

            • Robert RapcanRobert Rapcan
              Joined: Dec 6, 2018
              Posts: 7

              Sorry for the late answer.In our clinics we prefer cryo if the patient accepts temporary occipital sensory loss. If not, pulsed RF is the choice. In my country both procedures are currently covered by medical insurance.

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