Thalamic pain alleviated by stellate ganglion block: A case report

Abstract

Rationale: Thalamic pain is a distressing and treatment-resistant type of central post-stroke pain. Although stellate ganglion block is an established intervention used in pain management, its use in the treatment of thalamic pain has never been reported.

Patient concerns: A 66-year-old woman presented with a 3-year history of severe intermittent lancinating pain on the right side of the face and the right hand. The pain started from the ulnar side of the right forearm after a mild ischemic stroke in bilateral basal ganglia and left thalamus. Weeks later, the pain extended to the dorsum of the finger tips and the whole palmar surface, becoming more severe. Meanwhile, there was also pain with similar characteristics emerging on her right face, resembling atypical trigeminal neuralgia.

Diagnoses: Thalamic pain was diagnosed.

Interventions: After refusing the further invasive treatment, she was suggested to try stellate ganglion block.

Outcomes: After a 3-day period of pain free (numerical rating scale: 0) postoperatively, she reported moderate to good pain relief with a numerical rating scale of about 3 to 4 lasting 1 month after the first injection. Pain as well as the quality of life was markedly improved with less dose of analgesic agents.

Lessons: Stellate ganglion block may be an optional treatment for thalamic pain.

Figure 1

Brain MRI-DWI shows an old infarction focus in the left thalamus (white arrow). MRI-DWI = magnetic resonance image diffusion weighted imaging.