Experience with Gore’s Block in Patients with Lower Lumbar Radiculopathy

Abstract

Lower lumbar radiculopathy is one of the most common presentations in the pain clinic outpatient department (OPD). A thorough history, physical examination, neurological assessment, and imaging help in the diagnosis and management. The inability to identify the correct pain generator often causes a failure of treatment. Dr. Satishchandra Gore has proposed a new method for the diagnosis of affected lower lumbar nerve root (L5 and S1) at a peripheral level. His hypothesis is that in an inflamed nerve root, sodium channels are upregulated at both proximal and distal ends (central and peripheral). This results in tenderness at the distal peripheral end of the nerve on palpation. We can block the sodium channels at the distal portion of the same inflamed nerve, which may be able to abolish pain. This procedure is called “Gore’s Block” and the result is called “Gore’s sign.” We used this technique in 10 patients with suspected L5-S1 radiculopathy. Out of 10 patients, seven patients had pain relief after Gore’s block. These seven patients also responded well to a Caudal epidural steroid injection. Two patients did not have significant pain relief with Gore’s block and had poor responses to epidural steroid injections. One patient got therapeutic pain relief after Gore’s block, probably due to the natural resolution of the disease. Gore’s block is a simple, OPD procedure, helpful in diagnosing the level of nerve affection in lower lumbar radiculopathy. It is diagnostic and has a good correlation with epidural blocks. Whether it is therapeutic in nature needs to be further investigated.

Keywords

• caudal epidural
• gore’s block
• gore’s sign
• visual analog scale