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Interventional Pain Treatments in the Management of Oncologic Patients With Thoracic Spinal Tumor–Related Pain: A Case Series
Author(s) -
Rispoli Leia,
Rakesh Neal,
Shah Rita,
Gulati Amitabh
Publication year - 2019
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12813
Subject(s) - medicine , interventional pain management , surgery , radicular pain , spinal disease , intercostal nerves , cancer pain , thoracic vertebrae , lumbar , cordotomy , anesthesia , cancer , spinal cord , lumbar vertebrae , pain management , psychiatry
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.