Interventional pain treatments in the management of oncologic patients with thoracic spinal tumor–related pain: A case series Journal Article

Authors: Rispoli, L.; Rakesh, N.; Shah, R.; Gulati, A.
Article Title: Interventional pain treatments in the management of oncologic patients with thoracic spinal tumor–related pain: A case series
Abstract: Background: Advanced tumors of the thoracic spine are difficult to treat and can lead to complex pain syndromes. Following conventional oncologic treatments, pharmacologic therapy may be insufficient to manage pain. Minimally invasive interventional procedures offer alternatives to treat malignant thoracic spinal pain. Methods: Thirteen patients with metastatic disease and poorly controlled thoracic axial and/or radicular pain were identified via a retrospective chart review. Patients were either treated with radiation, surgery, chemotherapy, or a combination of these. Then, the patients were organized into groups based on their diagnoses, anatomical disease locations, symptoms, prior treatments, and interventional pain procedures offered. Results: All cases of intercostal nerve, costotransverse junction, erector spinae plane, and paravertebral blocks resulted in pain relief without any reported complications. A patient who received a thoracic epidural injection had a complete resolution of pain when combined with radiation therapy 2 weeks after the injection. One patient who underwent repeat thoracic epidural injections eventually had an intrathecal pump placement, resulting in reduced opioid usage. Finally, 1 patient who received a thoracic medial branch block with a relief of thoracic axial pain reported greater pain relief with a medial branch nerve cryoablation. Conclusion: We propose a treatment algorithm to manage patients with thoracic spinal tumor–related pain. Interventional thoracic axial procedures may be safe and efficacious pain treatments for patients with cancer. © 2019 World Institute of Pain
Keywords: adult; cancer chemotherapy; clinical article; controlled study; aged; middle aged; cancer surgery; case report; cancer patient; cancer radiotherapy; antineoplastic agent; metastasis; pain; mastectomy; dexamethasone; steroid; cancer pain; retrospective study; renal cell carcinoma; backache; lung metastasis; thorax pain; colon cancer; breast carcinoma; lung carcinoma; methylprednisolone; prostate adenocarcinoma; lidocaine; tumor; cryoablation; esophageal adenocarcinoma; bupivacaine; analgesia; intraductal carcinoma; chordoma; physiotherapy; spine metastasis; metastatic; fentanyl; gabapentin; oxycodone; nerve block; case study; spine tumor; triamcinolone; kyphoplasty; palliative; laminectomy; thoracic spine; spine instability; intrathecal; epidural; acute myeloid leukemia; radicular pain; baclofen; intercostal nerve block; medial branch block; spinal; very elderly; human; male; female; article; thorax epidural anesthesia; paravertebral block; neuraxial; paravertebral; methylprednisolone acetate; costotransverse junction block; erector spinae plane block; posterior spine fusion
Journal Title: Pain Practice
Volume: 19
Issue: 8
ISSN: 1530-7085
Publisher: Wiley Blackwell  
Date Published: 2019-11-01
Start Page: 866
End Page: 874
Language: English
DOI: 10.1111/papr.12813
PUBMED: 31273928
PROVIDER: scopus
Notes: Article -- Source: Scopus
Citation Impact
MSK Authors
  1. Amitabh Gulati
    76 Gulati