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Abstract
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Background and Aims Superior cluneal nerves (SCN) originate from the dorsal rami of lower thoracic and lumbar spinal nerves by their lateral cutaneous branches and provide sensory innervation of the posterior iliac crest, superior gluteal region and greater trochanter. A reliable SCN block may have application in management of chronic lower back pain, which has a high prevalence and frequently a neuropathic pain component. In this case report, we describe the use of ultrasound-guided SCN block technique for the management of chronic neuropathic post-herpetic pain located on lower back and gluteal region, refractory to initial pharmacological and topical treatment strategies.
Methods Male patient, 39 years-old presents with post-herpetic neuralgia and complaints of unilateral lower back and gluteal pain, with allodynia, burning and stabbing in affected area, NRS 6 and DN4 questionnaire 6/10. Initial pharmacological treatment with amitriptyline, gabapentin and tramadol with no adequate pain relief. Three topical capsaicin attempted with only partial relief, so an ultrasound-guided SCN block was performed with ropivacaine 0,2% and triamcinolone, with mapping of cutaneous allodynia area. Minutes after nerve block there was a significant reduction of the area, with pain intensity successfully decreased.
Area of pain before (blue) and after (green) ultrasound-guided SNC block technique
Conclusions Neuropathic pain is a major form of chronic pain with profound physical and psychological impact and it’s often challenging to manage due to its diversity of mechanisms and patients’ responses. In this case the SCN block provided the patient an effective pain relief due to the nerves contribution to the affected area, perhaps underlying a neuropathy-mediated SCN pain, which may benefit of longer relief with radiofrequency.