Open AccessRadiofrequency Treatment of the Thoracic Paravertebral Nerve Combined with Glucocorticoid for Refractory Neuropathic Pain Following Breast Cancer Surgery
Author(s) -
Ken Uchida
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/e277
Subject(s) - medicine , neuropathic pain , dermatome , anesthesia , breast cancer , surgery , cancer pain , nerve block , intercostal nerves , cancer
Background: Neuropathic pain following breast cancer surgery can have a profoundly negativeimpact on the physical and psychosocial functioning of patients. Radiofrequency treatment has beenused as therapy for chronic pain, which also has a problem under debate of its neurodestructivenature. Although the efficacy and safety of using glucocorticoids in nerve block treatment arecontroversial, they have been used to treat neuropathic pain for many years and have been usedto alleviate acute and continued postoperative pain. Neither radiofrequency combined withglucocorticoids nor radiofrequency treatment of the thoracic paravertebral nerve for neuropathicpain following breast cancer surgery has been reported.Objective: To describe the efficacy of thoracic paravertebral nerve radiofrequency treatmentcombined with glucocorticoids for refractory neuropathic pain following breast cancer surgery.Design: A series of 3 patients, who following breast cancer surgery with neuropathic pain thatdid not respond to conservative treatment, were selected. They received radiofrequency treatmentof the thoracic paravertebral nerve combined with betamethasone. If pain remained after thistreatment at a dermatome of a different level or at the same level, the same treatment wasadministered after at least 2 months had passed.Results: A total of 21 treatments were administered to the 3 patients. After these treatments,all 3 patients experienced pain relief and their quality of life improved as evaluated by the SF36. Hypoesthesia worsened slightly after treatment. However, anesthesia dolorosa and transientburning pain in the corresponding dermatome, which seemed to be related to neuro-injury afterradiofrequency treatment, were not seen.Conclusion: This case series suggests that it is possible that radiofrequency treatment of thethoracic paravertebral nerve combined with glucocorticoid may help in pain relief and improve thequality of life of patients with refractory neuropathic pain following breast cancer surgery.Key words: Radiofrequency, neuropathic pain, glucocorticoid, breast cancer surgery, thoracicparavertebral nerve, postmastectomy pain