University of Texas Southwestern, Department of Anesthesia and Pain Management, Dallas, TX, USA.
Pain Physician. 2013 May-Jun;16(3):E311-4.
Pain associated with cancer is often difficult to treat, even more so when tumors involve peripheral nerves. Therapy is complex and often requires a multimodal approach that can include medications, radiation, and interventional techniques. These components are utilized with variable success, but are also limited by known complications or adverse effects. We present the case of a 53-year-old woman with a metastatic axillary tumor that involved her brachial plexus. Attempts to control her pain with medication were unsuccessful despite escalation and use of adjunct agents. She was not deemed to be a surgical candidate due to the size and location of the tumor. Radiation was discussed but, obviously, would not work immediately. Our team decided to employ a brachial plexus catheter for continuous nerve block, which provided almost complete relief of pain. Since her pain was deemed to be of peripheral etiology, pulsed radiofrequency ablation of her brachial plexus was used for more long-term pain relief. The patient responded very well with minimal pain issues and no apparent complications. On follow-up, the patient had good relief for almost 2 months. Pulsed radiofrequency is a poorly understood technology that has increasing evidence for certain pain conditions; however, for cancer and peripheral nerves the evidence is slim to none. Our case presents a successful use for pain management of a brachial plexopathy due to a tumor. We propose that pulsed radiofrequency may present a non-neurodestructive pain management technique for tumors involving peripheral nerves, though more data is definitely needed.
与癌症相关的疼痛通常难以治疗,尤其是当肿瘤涉及外周神经时。治疗方法复杂,通常需要采用多模式方法,包括药物、放疗和介入技术。这些方法的应用取得了不同程度的成功,但也受到已知并发症或不良反应的限制。我们报告了一例 53 岁女性病例,其腋窝转移性肿瘤累及臂丛。尽管进行了药物升级和辅助药物治疗,但仍无法控制其疼痛。由于肿瘤的大小和位置,她不适合手术。曾讨论过放疗,但显然不能立即起效。我们的团队决定使用臂丛神经导管进行连续神经阻滞,这几乎完全缓解了疼痛。由于她的疼痛被认为是外周病因引起的,因此对其臂丛进行了脉冲射频消融以获得更长期的疼痛缓解。患者反应良好,疼痛问题极小,无明显并发症。随访时,患者的疼痛缓解近 2 个月。脉冲射频是一种理解不深的技术,对于某些疼痛状况有越来越多的证据支持;然而,对于癌症和外周神经,证据很少。我们的病例成功地应用了脉冲射频来治疗肿瘤引起的臂丛神经病。我们提出,脉冲射频可能为涉及外周神经的肿瘤提供一种非神经破坏性的疼痛管理技术,但肯定需要更多的数据。