AI Article Synopsis

  • Cancer pain significantly affects the quality of life, with up to 70% prevalence in advanced stages, and is managed using the WHO pain ladder that incorporates NSAIDs, opioids, and adjuvant medications.
  • A case study of a patient with metastatic colon cancer experiencing severe pain and immobility due to epidural metastasis illustrates the limitations of traditional pain management strategies.
  • The patient benefited from spinal cord stimulation, achieving over 80% pain relief and functional recovery, highlighting the need for alternative pain management solutions as the medical community shifts away from opioid reliance.

Article Abstract

Cancer pain has a substantial impact on the quality of life and functional capacity with a prevalence of up to 70 % in patients with advanced, metastatic, or terminal disease [1]. The WHO pain ladder has been used in practice to guide cancer pain management. A three-step ladder starts with NSAIDs and non-opioids for mild pain, weak opioids for mild to moderate pain and strong opioids for moderate to severe pain with the use of adjuvant medications such as TCAs and muscle relaxants at any stage for optimization (Fallon et al., Dec 2022) [2] We present a case of a patient with metastatic colon cancer who was admitted for intractable pain crisis and right sided L-5 radiculopathy secondary to epidural metastasis (Figs. 1 and 2). The patient's pain left her bedridden, unable to walk and remained refractory to an escalating intravenous opioid regimen and caudal epidural steroids. The patient subsequently underwent spinal cord stimulation (SCS) trial at level T-7 and achieved >80 % pain relief resulting in a markedly decreased opioid requirement and tremendous recovery of ambulatory function (Fig. 3). After sustained results, a permanent implant was placed at T-8 and patient remains discharged with functional restoration and continued pain improvement (Fig. 4). To our knowledge, this is a novel application of SCS for a refractory pain crisis secondary to a metastatic colon cancer induced radiculopathy presenting with severe functional impairment. As we transition away from opioid use, it is imperative as pain physicians, to investigate the potential of current as an alternative means of cancer pain management: a ubiquitous and challenging clinical conundrum.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372977PMC
http://dx.doi.org/10.1016/j.inpm.2023.100374DOI Listing

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