Retrograde Adriamycin Sensory Ganglionectomy: Novel Approach for the Treatment of Intractable Pain

BackgroundPain management for multiple bone metastases is complex and often requires multidisciplinary treatment. We herein describe patient-centered multidisciplinary pain management for metastatic cancer.Case presentation: A 61-year-old woman with multiple bone metastases of uterine cervical cancer developed intractable low back pain. After external beam radiotherapy failed, we performed lumbar spinal intralesional curettage, pedicle screw fixation, and nerve decompression. However, the neuralgia persisted. We then percutaneously injected epirubicin into the intervertebral foramina under computed tomography guidance for L5 dorsal root ganglion destruction. Osteoplasty was performed under C-arm X-ray guidance; however, the sacrum was mistaken for the ilium, and treatment was ineffective. We administered zoledronic acid and strontium-89. The last resort was outpatient implantation of an epidural bupivacaine-morphine infusion system. A visual analog scale (VAS) was used for pain evaluation. Lumbar spinal intralesional curettage and fixation, epirubicin-induced ganglion destruction, and administration of zoledronic acid and strontium-89 decreased her VAS pain score from 7–8 to 3–4. Radiotherapy and nerve decompression and release were ineffective, as was osteoplasty because of the location error. The epidural infusion system decreased the VAS score from 7–8 to 2–3 and was highly efficient.ConclusionsMultidisciplinary integrated treatment for metastatic cancer can be effective.

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“…Kato et al. 10 first reported satisfactory clinical effects of this method for the treatment of intractable neuropathic pain. He et al.…”

Section: Discussionmentioning

confidence: 99%

Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer

Qin

Song

et al. 2018

J Int Med Res

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“…Using a surgical approach to expose nerves, adriamycin has been administered directly into exposed nerves [5]. In these cases, the trigeminal nerve was injected in patients with trigeminal neuralgia or post‐herpetic neuralgia, resulting in 40–60% of patients having good analgesic results [5,6]. The onset of pain relief was relatively rapid, taking into account the time for retrograde transport [7].…”

Section: Discussionmentioning

confidence: 99%

“…Permission for “Innovative Therapy” was obtained from the Committee on Research in Human Subjects at the Massachusetts General Hospital, Harvard Medical School. The patient understood that this was an experimental procedure, and that adriamycin had been injected into surgically exposed nerves in human subjects for other types of neuropathic pain [4–6]. Full consent was obtained from the patient.…”

Section: Patient Historymentioning

confidence: 99%

“…Adriamycin, an anthracycline antineoplastic agent, is transported through sensory neurons via retrograde axoplasmic transport as demonstrated in animal models [4]. There are a few reports on the effects of intra‐neural injection of adriamycin for the treatment of post‐herpetic neuralgia [4,5] and idiopathic trigeminal neuralgia [6]. In these cases, patients had their trigeminal nerve exposed surgically prior to the injection of adriamycin.…”

Section: Introductionmentioning

confidence: 99%

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Adriamycin Injection into the Medial Cord of the Brachial Plexus: Computed Tomography-Guided Targeted Pain Therapy

Grant¹,

Gallagher

González³

et al. 2008

Pain Med

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Recent advances in radiographic imaging technology allow for therapeutic agents to be placed within the subepineurium of peripheral nerve tissue. Adriamycin, a chemotherapeutic agent, is retrogradely transported by nerves to their cell bodies residing in the dorsal root ganglia. The combined process of radiological approach, an understanding of the anatomy of the brachial nerve plexus, and the use of agents that are retrogradely transported by nerves allows for targeted neuroablation of nerves. Advantages of this allow for the use of very small volumes of even toxic drugs, the volume of which allows for safe administration. Here, we report on the transcutaneous computed tomography (CT)-guided injection of adriamycin into specific branches of the brachial plexus in a patient with metastatic cervical cancer involving the lower plexus whose pain was untreatable by aggressive medical therapy that included epidural trials of opioids. Identification of the medial brachial cord was achieved using CT-guided techniques that included accurate localization with intra-neural dye injection, followed by injection of 0.5 mg of adriamycin. The patient reported complete pain relief within 12 h of the injection.

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“…Two of these studies were RCTs: in one 44 radiofrequency lumbar ganglionectomy was compared to sham surgery for sciatica and in the other radiofrequency lesions made at 2 different temperatures were compared. 125 The remaining articles were case series ranging in size from 3 to 102 patients ( Table 2, 17 studies 29,34,44,52,56,64,76,80,85,89,112,125,126,131,138,152,154 ).…”

Section: Ganglionectomy Studiesmentioning

confidence: 99%

Destructive procedures for the treatment of nonmalignant pain: a structured literature review

Cetas

Saedi

Burchiel

2008

JNS

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Retrograde Adriamycin Sensory Ganglionectomy: Novel Approach for the Treatment of Intractable Pain

Cited by 20 publications

References 4 publications

Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer

Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer

Adriamycin Injection into the Medial Cord of the Brachial Plexus: Computed Tomography-Guided Targeted Pain Therapy

Destructive procedures for the treatment of nonmalignant pain: a structured literature review

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