Brachioradial pruritus treated with computed tomography-guided cervical nerve root block: A case series

Weinberg, Brent D.; Amans, Matthew R; Deviren, Sibel; Berger, Timothy G.; Shah, Vinil

doi:10.1016/j.jdcr.2018.03.025

Cited by 16 publications

(22 citation statements)

References 15 publications

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“…Of the three patients who underwent trans-foraminal epidural steroid injections (TFESI) of the cervical spine under CT guidance, immediate positive results were obtained in two. The third patient required repeated injections with the addition of mexiletine for relief [7]. This interventional pain procedure may be considered after more conservative therapies have been trialed.…”

Section: Discussionmentioning

confidence: 99%

Brachioradial pruritus in a 52-year-old woman: A case report

Berger

Urits

Orhurhu

et al. 2019

Case Reports in Women's Health

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Section: Discussionmentioning

confidence: 99%

Brachioradial pruritus in a 52-year-old woman: A case report

Berger

Urits

Orhurhu

et al. 2019

Case Reports in Women's Health

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“…Studies have demonstrated successful treatment of refractory BRP with topical capsaicin patches [7][8][9]. There are even reports of steroid injections, surgical decompression, cervical spine manipulation, and acupuncture in the management of BRP for underlying cervical disease [2,10]. Most notably, a study evaluating the use of topical amitriptyline-ketamine in post-herpetic neuralgia patients suggestedimproved symptomatic relief with higherdrugconcentrations (4% and 2% respectively) similar to concentrations used in our patient (5% and 10%) [11].…”

Section: Discussionmentioning

confidence: 99%

“…The disorder is characterized by more than just itching, some patients often describean associated burning, stinging, and/or tingling sensation [1]. Despite reports in the literature as early as 1968, the exact etiology of BRP remains elusive; currently, there are only 3 documented theories on the conditionnamely ultraviolet radiation, trauma, and cervical spine disease [2][3][4]. Effective care of these patients is not only confounded by the theories on pathogenesis but also on the limitations within the literature, which largely consist of case reports and case series.…”

Section: Introductionmentioning

confidence: 99%

Topical Therapy as a Treatmentfor Brachioradial Pruritis: a Case Report

2019

Journal of Case Reports: Open Access

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Management of brachioradial pruritus (BRP) presents a formidable challenge to dermatologists and neurologists. BRP is a rare, neurocutaneous condition characterized by sharply localized, chronic pain with associated itching, burning, stinging, and or tingling sensation. Effective care of this patient population is confounded by limitations within the literature, comprised of case series and case reports. We present a case of one middle-aged female with a chronic history of BRP recalcitrant to the following oral therapies: pregabalin, gabapentin, mirtazapine, prednisone, and amitriptyline, as well as topical triamcinolone. After being evaluated in the clinic, the patient was started on combination therapy withKetamine 10%, Amitriptyline 5%, and Lidocaine 5% topical cream to which she responded.

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“…Invasive treatments have been tried for refractory BRP or those with clear cervical spine pathology. 28,[31][32][33][34] One case noted dramatic improvement with botulinum toxin (100 IU total) injected at 1.5 cm intervals over the symptomatic area every five to six months. 31 Similarly, epidural steroid injections in four patients gave 75% of patients lasting relief from pruritus after one injection, while 25% required multiple injections to gain long-term relief.…”

Section: Procedural Treatmentsmentioning

confidence: 99%

“…31 Similarly, epidural steroid injections in four patients gave 75% of patients lasting relief from pruritus after one injection, while 25% required multiple injections to gain long-term relief. 33,35 A case of BRP associated with spinal cord injury was treated with stellate ganglion catheter placement and ropivacaine infusion, achieving partial pruritus relief. Side effects including upper extremity temperature change, piloerection, and conjunctival injection were noted.…”

Section: Procedural Treatmentsmentioning

confidence: 99%

Treatment of Brachioradial Pruritus: A Systematic Review

2019

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Importance: Brachioradial pruritus (BRP) is a poorly understood disease and can severely impact quality of life. However, there is currently no clear treatment. Objective: To identify effective behavioral, topical, oral, and invasive treatment options for BRP, and to discuss the quality of the data currently found in the literature. Evidence Review: The PubMed and CINAHL databases were systematically reviewed for articles from 1968 to the present containing search terms “brachioradial OR solar OR forearm AND pruritus OR itching.” Results were narrowed to articles written in English, focusing specifically on BRP, and that stated precise treatment modalities. Evidence quality was determined based on the study type. Findings: Thirty-six articles discussing treatments for BRP are included in this review with a total 399 patients. Six studies (n=68) report on the efficacy of capsaicin cream, eight studies (n=26) on oral gabapentin 300 mg daily to six times daily and four studies (n=98) on sun protection. The remaining articles comprise of low-quality, small-scale studies on further oral medications, physical therapy, minimally-invasive procedures, and surgery. Conclusions and Relevance: Low-quality evidence supports the use of sun protection, topical capsaicin, or oral gabapentin as effective therapeutic modalities for BRP. Clinicians should be aware of possible underlying cervical spine pathology and include thorough imaging as part of BRP work-up. Further high-quality studies on BRP treatments would help elucidate clear management for this disorder.

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Brachioradial pruritus treated with computed tomography-guided cervical nerve root block: A case series

Cited by 16 publications

References 15 publications

Brachioradial pruritus in a 52-year-old woman: A case report

Brachioradial pruritus in a 52-year-old woman: A case report

Topical Therapy as a Treatmentfor Brachioradial Pruritis: a Case Report

Treatment of Brachioradial Pruritus: A Systematic Review

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