Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer

Abstract

BackgroundPain management for multiple bone metastases is complex and often requires multidisciplinary treatment. We herein describe patient-centered multidisciplinary pain management for metastatic cancer.Case presentation: A 61-year-old woman with multiple bone metastases of uterine cervical cancer developed intractable low back pain. After external beam radiotherapy failed, we performed lumbar spinal intralesional curettage, pedicle screw fixation, and nerve decompression. However, the neuralgia persisted. We then percutaneously injected epirubicin into the intervertebral foramina under computed tomography guidance for L5 dorsal root ganglion destruction. Osteoplasty was performed under C-arm X-ray guidance; however, the sacrum was mistaken for the ilium, and treatment was ineffective. We administered zoledronic acid and strontium-89. The last resort was outpatient implantation of an epidural bupivacaine-morphine infusion system. A visual analog scale (VAS) was used for pain evaluation. Lumbar spinal intralesional curettage and fixation, epirubicin-induced ganglion destruction, and administration of zoledronic acid and strontium-89 decreased her VAS pain score from 7–8 to 3–4. Radiotherapy and nerve decompression and release were ineffective, as was osteoplasty because of the location error. The epidural infusion system decreased the VAS score from 7–8 to 2–3 and was highly efficient.ConclusionsMultidisciplinary integrated treatment for metastatic cancer can be effective.

<p>Clinical Characteristics and Prognostic Analysis of Gynecologic Cancer with Spinal Metastases: A Single-Center Retrospective Study</p>

“… 1 – 3 However, some patients still relapse or develop metastases within 2‒3 years after treatment. 4 , 5 Many patients develop pelvic or distant metastases during or after treatment, which can be metastatic to bones, liver, brain, lungs or kidneys. In China, GC accounts for about 12% of all cancer types in women.…”

A pathological toe fracture as the first presentation of cervical cancer

“…[6] At present, the clinical treatment of cervical cancer with bone metastasis is comprehensive treatment, which includes surgery, radiotherapy, chemotherapy, and bisphosphonate drugs. [5,13] When extraskeletal metastases appear at the same time, patients predominantly accept palliative treatment. [7] It needs to be clarified that we took palliative treatment for patients and the clinical progression of disease does not benefit from only surgery.…”

Intervertebral foramen injection of plerixafor attenuates CCD-induced low back&nbsp;pain&nbsp;in&nbsp;rats through down-regulation of Nav1.8 and Nav1.9

“…All these unique characteristics make the DRG an ideal target for the treatment of chronic pain [43]. Clinically, the local anesthetics and steroid were usually injecting into the intervertebral foramina to block the electrogenesis and pain conduction at DRG level to cure various kinds of pain with the assistance of visual equipment, like the ultrasound and computed tomography [44]. In the present study, we provided preclinical evidence that intervertebral foramina injection at the compressed DRG of plerixafor or local anesthetics was su cient to reverse the CCD-induced multiple pain behaviors.…”