Neurostimulation Therapy for Cancer-Related Neck and Arm Pain
Alexander E. Yakovlev, MD | Beth E. Resch, APNP
BACKGROUND AND AIMS
Two-thirds of patients with cancer are affected by pain and 10-15% of these do not achieve acceptable levels of relief with opiates alone or in combination with adjuvant analgesics . Interventional approaches have received considerable attention in an attempt to provide pain relief for these patients. Neurostimulation including spinal cord stimulation (SCS) has been used for treatment of intractable cancer pain.
MATERIALS AND METHODS
A 52-year-old male with history of head and neck neoplasm treated with radical neck dissection and radiotherapy experienced resultant intractable left neck and arm pain. He failed conservative treatment and multiple injections. He survived five years after the surgery and had no evidence of local recurrence or metastases. He underwent successful trial of percutaneous placement of two 8-electrode epidural leads (Medtronic Inc., Minneapolis, MN). Epidural access was gained at the T3/T4 interspace with final leads positioned at C4-C5-C6. During the 2-day SCS trial the patient reported greater than 50% improvement in pain. Three weeks later the patients underwent implantation with permanent leads and RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator.
RESULTS
After final implantation the patient reported >75% reduction in VAS. He was able to discontinue use of pain medications, reported weight gain, the ability to return to social activities and improved family relations. At 12 months post-implant, the patient continued to report good pain control (VAS scores 2-3 out of 10) and improved functional status.
CONCLUSION
Neurostimulation can be a therapeutic alternative for patients with cancer related neck and upper extremity pain who in the past exhausted all available treatments. SCS is an important adjuvant option in patients with the pain associated with head and neck tumors.
FIGURES
LEARNING OBJECTIVES
1. The role of neuromodulation in cancer pain
2. The efficacy of SCS in treatment of cancer related pain
3. Therapeutic option for cancer-related pain
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