New IR techniques provide relief for patients with migraine, plantar fasciitis

Research presented this week at the Society of Interventional Radiology’s Annual Scientific Meeting in Atlanta demonstrate that an innovative IR treatment can be used to treat chronic conditions that afflict millions of Americans and result in millions of visits to emergency rooms and physician offices.

In one study researchers used an IR technique to provide migraine sufferers with enough ongoing relief that they can reduce the amount of medication needed to relieve their pain.

“Anyone who has experience migraine headaches can tell you it can be debilitating,” said Kenneth Mandato, MD, an interventional radiologist at Albany Medical Center and the lead researcher for the study called, “Image-guided sphenopalatine ganglion blocks: An IR solution for chronic headaches.”

“Unfortunately migraines are very common in the U.S.,” said Mondato. “Nearly 20% of adults 18 to 65 state they have chronic daily headaches requiring medication. Over three million emergency rooms visits a year are for headache management—a true economic and productivity burden.” Mondato also pointed out that patients suffering from migraines frequently turn to medications that are costly and carry significant side effects.”

The treatment used in the study involves the administering of insertion of a spaghetti-sized catheter through the nasal passages through which 4% lidocaine is administered to the sphenopalatine ganglion, a nerve bundle behind the nose associated with migraines.

Before treatment, on a scale of 1 to 10 to determine the degree of debilitation patients experienced from a migraine headache, patients averaged a score of 8.25. A day after the treatment those scores were cut in half, to an average of 4.10. In addition, 88% of patients reported they required less or no migraine medication for ongoing relief.

“Administration of lidocaine to the sphenopalatine ganglion acts as a ‘reset button’ for the brain’s migraine circuitry,” Mandato said. “When the initial numbing of the lidocaine wears off, the migraine trigger seems to no longer have the maximum effect that it once did. Some patients have reported immediate relief and are making fewer trips to the hospital for emergency headache medicine.”

Another IR treatment reported on at the SIR’s Annual Scientific Meeting involved plantar fasciitis.

“Chronic plantar fasciitis is the most common debilitating foot complaint affecting approximately 10% of the population and accounting for over 1 million office visits,” said Rahul Razdan, MD, an interventional radiologist at Advanced Medical Imaging in Lincoln, Neb., and one of the lead researchers on the study called “Percutanious ultrasonic fasciotomy: A novel approach to treat chronic plantar fasciitis.”

“The standard treatments for plantar fasciitis include pain medication, activity modification, physical therapy and arch supports,” Razdan explained. “However they don’t offer permanent relief. There are also surgical options, but these are known to have longer recovery times.”

In this study, researchers utilizing ultrasound imaging and specific ultrasound energy to penetrate, emulsify and remove diseased fasciitis tissue, with the idea that permanently removing the diseased tissue allows room for the healthy tissue to regrow in its place. About 100 patients were treated, beginning in August 2013. These patients had previously failed to respond to medications, activity modification and arch supports as treatments for chronic refractory plantar fasciopathy.

Two weeks after treatment, more than 90% of the patients reported improvement in the symptoms—improvements that were maintained at six months. Patients also reported having no treatment-related complications.

“We are excited to see this treatment help people return to their daily activities that their condition once prevented them from enjoying,” Razdan said. “While long-term outcome studies are in progress, the results that we have seen to date are very promising."

Mandato and Razdan participated in a teleconference arranged by SIR prior to the meeting.