Article

Cancer pain management is comprehensive, and it generally begins with
pharmacotherapy in a step-wise approach per analgesic guidelines established
decades ago by the World Health Organization. This analgesic ladder involves the
prescribing of co-analgesics, adjuvants, and opioids, with each step depending on
pain severity. Although the majority of cancer pain responds to this strategy,
there exist patients who do not respond adequately or experience significant side
effects or intolerance to pain medications. It is in these patients whom
clinicians consider interventional approaches. One approach to manage unremitting
unilateral malignant pain includes evaluation for cordotomy, which is an approach
that has been effective in such cases. We present a patient with breast cancer
metastatic to the pelvis, with associated severe pelvic and right lower limb
pain. Due to progressive disease, her pain worsened despite aggressive opioid
dose escalations. She ultimately underwent percutaneous left anterolateral
cervical cordotomy for malignant right leg pain, resulting in complete resolution
of leg pain. We propose that, in select patients with neoplasm-related pain,
cordotomy may prove very effective.
LEVEL OF EVIDENCE: V.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS