title: Sphenopalatine ganglion block for the treatment of myofascial pain of the head, neck, and shoulders.
abstract: OBJECTIVE
  This study examined the effectiveness of sphenopalatine ganglion block (SPGB) for myofascial pain syndrome of the head, neck, and shoulders using a double-blind, placebo-controlled, crossover study design with comparison to an internal standard consisting of trigger point injections (TPI).
  
  
  METHODS
  Patients (n = 23) were randomly assigned to receive either: (1) SPGB with 4% lidocaine, then TPI with 1% lidocaine, and finally SPGB with saline placebo or (2) SPGB with saline placebo, then TPI with 1% lidocaine, and finally SPGB with 4% lidocaine. Each respective treatment within each protocol was given sequentially at 1-week intervals for both groups. Prior to the first treatment, all patients assessed their average intensity of pain and pain at that particular moment using a visual analog pain scale. Pain intensity and pain relief were reassessed 30 minutes after each treatment and at 6 hours, 24 hours and 1 week using visual analog pain and pain relief scales. Pain intensity and pain relief data were transformed into natural logarithm units, and the statistical significance of SPGB with 4% lidocaine versus SPGB with placebo, SPGB with 4% lidocaine versus TPI, and TPI versus SPGB with placebo were tested by mixed-model analysis of variance. The magnitude of the differences in pain intensity and pain relief ratings were also compared via computation of 95% confidence intervals.
  
  
  RESULTS
  The analgesic effect of SPGB with 4% lidocaine was no better than placebo. Mixed-model analysis of variance revealed improved analgesia with administration of TPIs as compared to SPGB with 4% lidocaine and placebo over the entire week of observations (pain relief scores).
  
  
  CONCLUSIONS
  This study suggests that SPGB with 4% lidocaine is no more efficacious than placebo and less efficacious than administration of standard trigger point injections in the treatment of myofascial pain of the head, neck, and shoulders.
authors.affiliation: Pain Medicine Center, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia 19104, USA.
authors.forename: F M
authors.initials: FM
authors.lastname: Ferrante
authors.forename: A G
authors.initials: AG
authors.lastname: Kaufman
authors.forename: S A
authors.initials: SA
authors.lastname: Dunbar
authors.forename: C F
authors.initials: CF
authors.lastname: Cain
authors.forename: S
authors.initials: S
authors.lastname: Cherukuri
mesh_terms: D000328:Adult; D001340:Autonomic Nerve Block; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006257:Head; D006801:Humans; D008297:Male; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000628:therapy*; D009333:Neck; D012782:Shoulder