Department of Pain Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Department of Pain Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
Neuromodulation. 2023 Apr;26(3):694-699. doi: 10.1016/j.neurom.2023.01.018. Epub 2023 Mar 2.
Patients with spinal lesions or vertebral compression fractures from multiple myeloma often present with back pain that restricts their ability to lie flat and prevents them from undergoing cancer treatment. Temporary, percutaneous peripheral nerve stimulation (PNS) has been described for cancer pain secondary to oncologic surgery or neuropathy/radiculopathy from tumor invasion. The purpose of this case series is to show the use of PNS as an analgesic bridge therapy to treat myeloma-related back pain and allow patients to complete their course of radiation.
Temporary, percutaneous PNS was placed under fluoroscopic guidance for four patients with unremitting low back pain secondary to myelomatous spinal lesions. Before PNS, the patients had pain refractory to medical management and were unable to tolerate radiation mapping and treatment owing to low back pain while supine. Patients were followed with routine clinic visits to monitor pain and progression through cancer therapy. PNS was removed after approximately 60 days or after completion of radiation.
This case series presents four successful cases of PNS to treat low back pain from myelomatous spinal lesions and associated vertebral compression fractures. PNS targeted the medial branch nerves to treat both nociceptive and neuropathic low back pain. All four patients successfully completed radiation therapy with PNS in place.
PNS can effectively treat low back pain secondary to myeloma-related spinal lesions as a bridge therapy to radiation. The use of PNS is a promising option for back pain from other primary or metastatic tumors. Further research is needed into the use of PNS for cancer-related back pain.
患有多发性骨髓瘤所致脊柱病变或椎体压缩性骨折的患者常因背痛而限制其平卧能力，从而无法接受癌症治疗。暂时的经皮外周神经刺激（PNS）已被用于治疗因肿瘤手术或肿瘤侵袭引起的神经病/神经根病引起的癌症疼痛。本病例系列的目的是展示 PNS 作为镇痛桥接治疗在治疗骨髓瘤相关背痛方面的应用，使患者能够完成放射治疗。
在透视引导下，为 4 名因骨髓瘤脊柱病变引起持续腰痛的患者放置临时经皮 PNS。在 PNS 之前，患者因疼痛而对药物治疗无反应，并且由于平卧时腰痛而无法耐受放射治疗图和治疗。通过常规门诊就诊监测疼痛和癌症治疗进展。PNS 在大约 60 天后或放射治疗完成后被移除。
本病例系列成功地治疗了 4 例因骨髓瘤脊柱病变和相关椎体压缩性骨折引起的腰痛的 PNS 病例。PNS 针对内侧支神经治疗伤害感受性和神经性腰痛。所有 4 名患者均成功地在 PNS 存在的情况下完成了放射治疗。
PNS 可有效治疗骨髓瘤相关脊柱病变引起的腰痛，作为放射治疗的桥接治疗。PNS 的使用是治疗其他原发性或转移性肿瘤引起的腰痛的一种很有前途的选择。需要进一步研究 PNS 在治疗癌症相关腰痛方面的应用。
