Severe unexplained loin pain (loin pain haematuria syndrome): management and long-term outcome

Abstract

We recommend that patients be managed in a regional pain clinic, where a multidisciplinary approach promotes self-management of pain. Patients who were able to accept conservative treatment, and taper or withdraw opiate analgesia, had a better prognosis.

Lumbar Sympathetic Chain Neuromodulation with Implanted Electrodes for Long-Term Pain Relief in Loin Pain Haematuria Syndrome

“…There have been many reports of association between LPHS and depression, somatization and drug seeking behavior with suggestions that LPHS may represent a type of somatoform pain disorder (14–19). In contrast others have suggested that psychological disability improves as the pain symptoms improve (20).…”

“…Management of LPHS is challenging and a multidisciplinary approach with close liaison between pain specialists, renal physicians and psychiatrists should be adapted from the outset (19). It has been reported that approximately 30% of patients will experience a spontaneous resolution of their symptoms after a mean of 3.5 years with conservative medical management (5).…”

“…Complications included return of pain in the graft following reinnervation (37), graft failure requiring nephrectomy, and onset of pain in the contra lateral kidney (23). Due to the varying long‐term success rate and the associated risks and complications, surgical options are considered at a late stage and as a last resort or not at all (19).…”

Bilateral Renal Autotransplantation May Be an Effective and Definitive Treatment in Case of Loin Pain Haematuria Syndrome

“…Advocates of non-surgical management have failed to show persistent success in pain relief by their non-specific management (pain medication, antidepressants, ureteral capsaicin infusion, ureteric bupivicaine infusion) [4][5][6] . Moreover, frequent secondary effects associated with these therapies ranged from mild to severe, with cases of nephrectomy after capsaicin injection reported or subsequent dependency on opiates.…”

A Patient With Loin Hematuria Syndrome and Chronic Flank Pain Treated With Pulsed Radiofrequency of the Splanchnic Nerves

“…By utilizing PRF instead of a neurolytic agent, side effects such as inflammation and necrosis are also avoided. 4 The exact mechanism of action for PRF has not been fully elucidated and is still under scientific review. Some have suggested that the electrical field produced in PRF leads to alterations in nerve membrane function.…”