Interventional pain management for sacroiliac tumors in the oncologic population: A case series and paradigm approach Journal Article

   


Authors: Hutson, N.; Hung, J. C.; Puttanniah, V.; Lis, E.; Laufer, I.; Gulati, A.
Article Title: Interventional pain management for sacroiliac tumors in the oncologic population: A case series and paradigm approach
Abstract: Introduction: Tumors invading the sacrum and/or ilium often represent incurable metastatic disease, and treatment is targeted toward palliation of symptoms and control of pain. As systemic opioid therapy is frequently inadequate and limited by side effects, a variety of interventional techniques are available to better optimize analgesia. Using six patients as a paradigm for interventional approaches to pain relief, we present a therapeutic algorithm for treating sacroiliac tumor-related pain in the oncologic population. Methods: We describe the use of ultrasound-guided proximal sacroiliac joint corticosteroid injection, sacroiliac lateral branch radiofrequency ablation, percutaneous sacroplasty, and implantable neuraxial drug delivery devices to treat malignant sacroiliac pain in six patients. Pre- and postprocedure numerical rating scale (NRS) pain scores, duration of pain relief, and postprocedure pain medication requirements were studied for each patient. Results: Each patient had marked improvement in their pain based on an average postprocedure NRS difference of six points. The average duration of pain relief was eight months. In all cases, opioid requirements decreased after the intervention. Discussion: Depending on tumor location, burden of disease, and patient preference, patients suffering from metastatic disease to the sacrum may find benefit from use of ultrasound-guided proximal sacroiliac joint corticosteroid injection, sacroiliac lateral branch radiofrequency ablation, percutaneous sacroplasty, dorsal column stimulator leads, and/or implantable neuraxial drug delivery devices. We provide a paradigm for treatment in this patient population. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
Keywords: aged; aged, 80 and over; middle aged; case report; multimodality cancer therapy; combined modality therapy; cancer pain; algorithms; algorithm; spinal neoplasms; pain measurement; analgesics; analgesia; catheter ablation; injections, spinal; analgesic agent; ultrasonography, interventional; pain management; low back pain; nerve block; spine tumor; drug implant; complication; procedures; sacroiliac joint; drug implants; very elderly; humans; human; male; female; spinal cord stimulation; intraspinal drug administration; administration and dosage; interventional ultrasonography
Journal Title: Pain Medicine
Volume: 18
Issue: 5
ISSN: 1526-2375
Publisher: Oxford University Press  
Date Published: 2017-05-01
Start Page: 959
End Page: 968
Language: English
DOI: 10.1093/pm/pnw211
PUBMED: 28339540
PROVIDER: scopus
PMCID: PMC6279274
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85043384863&doi=10.1093%2fpm%2fpnw211&partnerID=40&md5=49e7bb9852c6380901a7f67da64fa114
Notes: Article -- Export Date: 2 April 2018 -- Source: Scopus
Altmetric
What is Altmetric?
Citation Impact
What is Dimensions Citation Badge?
BMJ Impact Analytics
MSK Authors
  1. Amitabh Gulati
    146 Gulati
  2. Eric Lis
    138 Lis
  3. Vinay Ganesh Puttanniah
    25 Puttanniah
  4. Ilya Laufer
    146 Laufer
  5. Joseph C Hung
    14 Hung
Related MSK Work