Successful Control of Pain from Malignant Psoas Syndrome by Spinal Opioid with Local Anesthetic Agents

Abstract

The findings in the present cases indicate neuraxial analgesia may be of benefit, in terms of managing pain and improving functional status, in MPS patients with insufficient pain control by multimodal analgesic treatment. Physicians should consider the use of neuraxial analgesia in cases of MPS where pain is uncontrolled with multimodal analgesic treatment to provide the best possible quality of life for patients with MPS.

Malignant psoas syndrome associated with gynecological malignancy: Three case reports and a review of the literature

“…The survival of patients with MPS is considered to be very short, as demonstrated by many previous studies, and the reported median survival duration was 5.5-10.7 months after diagnosis (2,4,19,23). In the present study, patients in cases 1 and 2 died at 8 and 7 months from the time of diagnosis, respectively.…”

“…Recent studies have shown that rotation switching of opioids to methadone was effective for refractory neuropathic pain (6,20). Other studies reported the efficacy of intervention strategies, including epidural analgesia (9,19), injection from a psoas sheath catheter (21) or intrathecal catheter (19,22), and dorsal rhizotomy (23). Radiotherapy is occasionally adapted for both cancer-directed and palliative therapy, although its efficacy remains to be clarified (1,2,4,5).…”

Malignant psoas syndrome: first pediatric case report in Mexico

“…Therapeutic options include NSAIDS, steroids, neuromodulators, opioids, local anesthetics and radiotherapy. 3,8,9 Optimal treatment of MPS should include early recognition, targeted cancer therapies (comprehended radiation therapy or surgical removal when possible), and evidence-based polymodal pharmacotherapy. 4…”

Psoas muscle metastatic disease mimicking a psoas abscess on imaging

“…Some centres have shown that epidural analgesia can be effective to relieve pain to allow patients to undergo effective radiotherapy in this case 8. Various, more invasive, methods have been successful to control pain associated with MPS such as psoas sheath catheters, spinal opioids and local anaesthetics and dorsal rhizotomy 9–11…”

“…When it does occur, the iliopsoas muscle is most commonly involved 2. Pain is a common presenting feature and there are numerous ways this can be managed to improve the quality of life of affected patients 4–11. However, adequate treatment requires a firm diagnosis, and muscular metastasis can adopt a range of appearances on imaging therefore making this a difficult task as they may mimic the more common psoas abscess or haematoma 1 2 12.…”