A Diagnosis and Treatment of the Critical Limb Ischemia: Pain Management

Abstract

Vascular diseases represented by obstructive arteriosclerosis(ASO) often cause resting pain or ulcer/necrosis as the disease progresses. The pain of critical limb ischemia (CLI) is severe and is difficult to control. In order to relieve pain, it is necessary to combine various treatment modalities such as drug therapy, regional anesthesia in the form of sympathetic ganglion block, epidural block, or peripheral nerve block (PNB), spinal cord stimulation, and hyperbaric oxygen therapy. Since patients are often elderly and may have severe heart disease, treatment modalities that have lesser effects on the circulatory system are desirable. Regional anesthesia is advantageous in that it exerts an anesthetic effect limited to the necessary region. This is particularly true of PNB performed under ultrasound guidance, wherein the effect of the PNB can be precisely limited to the necessary part. Furthermore, PNB is also effective in relieving pain during movement. In these respects, PNB is superior to analgesics delivered by systemic administration, such as opioids. It is also necessary to consider psychosocial factors as well as cognitive behavioral therapy and mirror therapy, in addition to drug therapy and ultrasound-guided PNB, in the management of pain in CLI.