Cervical plexus as anatomical target for the treatment of postoperative cervical neuropathic pain.

Objective: The incidence of chronic neuropathic pain following neck dissections is approximately 40%. Standard drug therapy in these patients include pharmacologic treatments due to the neuropathic pain (gabapentinoids, tricyclic antidepressants…). In this case, standard options were limited. The addition of ultrasound guidance to invasive pain management techniques has enabled us to successfully treat pathologies in which previous treatments options had been limited. Pulsed radiofrequency (PRF) ablation permits treatment over nerve structures that, due to either their morphological or functional characteristics, could not be approached using the conventional variant. Case report: A 45-year-old man with severe postoperative pain after undergoing partial glossectomy and functional neck dissection for squamous cell carcinoma of the tongue. The patient had been treated pharmacologically for several years with minimal results, baseline VAS of 90. After a successful superficial cervical plexus block under ultrasound guidance, he underwent PRF for a possible long-lasting effect. VAS post PRF improved in subsequent visits: VAS at 1 month was 0; at 3 months was 10 and at 6 months was 60. Conclusion: Postoperative changes to include alterations in nerve structures are a frequent source of chronic pain. The incidence of this type of pain in the cervical region is quite variable. Noninvasive treatment options are limited and oftentimes ineffective. Due to its location, superficial cervical plexus is an anatomical site with the potential risk of undergoing structural alterations (fibrosis, radiotherapy-associated retraction phenomena or neuroma formation). Interventional treatments performed under ultrasound guidance allow the dynamic application of therapies such as radiofrequency ablation. PRF could potentially cause an additive effect between neuromodulation and the hydrodissection caused by the infiltration of substances within a fibrotic area.

Osteoid Osteoma: Benign Osteoblastic Tumor of the Lumbar L4 Transverse Process Associated with Radicular Pain: A Case Report.

Osteoid osteomas of the spine are benign bone tumors typically presenting with progressive pain without neurological deficit. This report presents a case of an osteoid osteoma in the lumbar spine associated with radicular pain. The patient, a young male athlete, presented with severe chronic nightly left low-back pain radiated to the ipsilateral lower extremity who failed to respond to physical therapy and analgesic medications. Initial radiologic examination was reported as normal, but closer inspection of the T1- and T2-weighted magnetic resonance image as well as technetium-99m total body bone scan and a computed tomography scan revealed a bony lesion in the left transverse process of the L4 vertebra consistent with the diagnosis of osteoid osteoma. A selective L3 nerve root block provided significant relief. Surgical excision of the osteoid osteoma resolved the symptoms. This case emphasizes the importance of early suspicion and diagnostic interventions in the detection and treatment of osteoid osteoma.

Percutaneous sacroplasty and sacroiliac joint cementation under fluoroscopic guidance for lower back pain related to sacral metastatic tumors with sacroiliac joint invasion.

Cancer patients with bone metastases are at risk of a variety of skeletal events, including vertebral compression and pathologic fractures. Approximately 30% to 40% of patients with advanced lung cancer will develop bone metastases in the course of their disease, resulting in a significant negative impact on both morbidity and survival. Skeletal complications of bone metastases include pain, pathologic fractures, spinal cord compression, and hypercalcemia. The spine is the most frequent site of skeletal metastases. We present a 48-year-old female with intractable and incapacitating low back pain because of metastatic bone tumor in the left lateral side of S1 and S2 with left sacroiliac invasion. Imaging identified a metastatic invasion of the sacrum. Percutaneous sacroplasty, a safe and effective procedure for sacral-insufficient fractures, was performed under fluoroscopy guidance. However, the expected pain relief was not achieved. At 1 month, the patient remained invalided by severe back pain, which was localized to the left sacroiliac joint. In a second procedure, the sacroiliac joint was cemented. Pain relief was complete, immediate, and sustained until the patient's death related to the underlying oncologic disease. No complications were observed. Few reports exist about the treatment of sacral metastatic tumors with percutaneous sacroplasty. Further, no previous reports about sacroiliac joint cementation for joint stabilization have been found. In the present case, sacroiliac joint cementation successfully resolved residual pain that remained despite percutaneous sacroplasty treatment of the pathologic sacral fracture.

Tratamiento sintomático del dolor en el pacientes con cáncer / Treatment symptomatic of the pain in the patients with neoplasms

El dolor es el síntoma observado con más frecuencia en los pacientes con enfermedad cancerosa. Cerca de un 90 por ciento de estos pacientes pueden ser exitosamente tratados y controlados mediante la combinación de fármacos analgésicos y coadyuvantes utilizando primordialmente la vía oral. Una escogencia acertada del medicamento, dosis apropiadas y esquemas de horarios continuos, con la finalidad de mantener un nivel bajo de dolor, es la meta a alcanzar. Cuando esto no es posible de lograr, se imponen las técnicas invasivas, las cuales deben ser implementadas tempranamente y no dejarlas para la etapa final de la enfermedad. Un equipo multidisciplinario sería el encargado de guiar y recomendar las conductas a seguir durante el transcurso de la enfermedad. No se justifica en estos momentos que un paciente con cáncer sufra o muera con dolor