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WFSA Pain Management Fellow - Dr. Marjory Ayma Palacios

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Dr Marjory with her supervisor Dra. Erica Bernich

Dr Marjory Ayma Palacios works in the Instituto Nacional de Enfermedades Neoplasicas in Lima, Peru. In 2019, Dr Palacios completed a two-month Pain Medicine Fellowship in Buenos Aires, Argentina.

What did you enjoy most about your fellowship?

Over the course of the fellowship, I was fortunate enough to visit different hospitals and clinics that provided me with the opportunity to learn an interdisciplinary approach towards the oncological and non-oncological management of pain. In addition, I was able to observe interventional treatment options, such as nerve blocks, radiofrequency, nerve neuromodulation, intrathecal pump controlled by fluoroscopy and ultrasonography to obtain a more accurate approach. I was particularly pleased to observe many cases of interventionism under ultrasound and fluoroscopic guidance.

I would have been unable to access this level of comprehensive learning without attending the seminars, conferences and workshops organised by the Pain Foundation. Most notably, I was able to attend the 2019 Latin American Congress of Anesthesiology (CLASA) in Argentina.

The fellowship helped me to better understand the importance of communication between doctors and patients because when an adequate clinical history is taken, a better interdisciplinary approach in the treatment of pain can be achieved.

How will you use the knowledge and skills you’ve gained in your home institution?

I would like to apply the knowledge I have acquired in the pain unit of my hospital by introducing pain intervention as a treatment option. I am also keen to conduct workshops regarding ultrasound guidance and fluoroscopy. In addition, I would like to form working groups to conduct future research and present these at national and international conferences. In the future, I would like to hold congresses to integrate the pain management teams across Latin America.

Case Study 

Case Details

34-year-old female patient, with 5-year disease time, diagnosed with Trigeminal Neuralgia, paroxysmal, pain symptoms - unilateral, severe, penetrating, short-term, recurrent, located at the lower mandibular level, unilateral, of moderate intensity, with periods of crisis, which is not alleviated by carbamazepine 1200 mg C / 24 hours.

Surgical history: Decompression of the trigeminal nerve 3 years ago, Radiofrequency of the trigeminal nerve twice a year ago, with periods of improvement of 6 months.

Despite the continuous treatment described with pain, the neurostimulation of the implantable trigeminal nerve is decided.

Participation Opportunities

Picture1Prior to surgery, my supervising doctor and I evaluated the patient which included conducting a medical history and analysing his case.

While in the operating room, I observed every step of the procedure, from the preparation of the neurostimulation equipment to the introduction of the catheter under radioscopy.

What did you learn from the case?

I learned that trigeminal neuralgia is characterised by recurrent pain symptoms "paroxysmal, unilateral, severe, penetrating, short-term pain, located in the distribution of one or more of the branches of the V cranial nerve."

The medical treatment represents the first therapeutic step for pain control; the decision of the therapeutic modality to be applied must be made after analysing the physical state of the patient, and after evaluating the different techniques. Radiofrequency thermocoagulation of the Gasser ganglion has advantages and disadvantages, but it lacks mortality, achieving relief in 75% of patients, but peripheral neurostimulation is also an option. Trigeminal neuralgia is a difficult to manage entity with discrete percentages of pain relief through drug treatment. Interventional techniques are an effective alternative for pain control.

Further resources

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