Unusual Onset of Singultus As A Rare Result of Epidural Steroid Injection at a Varied Vertebral Level: A Case Report

Abstract

Objective Cervical epidural steroid injections (ESI) can provide effective pain management for patients suffering from chronic neck pain due to degenerative disc disease or various pathological changes of the cervical spine. There are several rare adverse effects reported from interventional pain procedures, including persistent hiccups (singultus). Based on the limited number of cases with this adverse outcome, we propose a treatment algorithm for singultus after ESI (Fig. 3).Case Report: While rare, singultus has been documented as an adverse effect of various interventional pain procedures, including epidural steroid, facet joint, and sacroiliac joint injections. We describe the case of a general contractor who presented to clinic with chronic neck pain and central canal stenosis. The patient received an uncomplicated lumbar epidural steroid injection in the past and was recommended for an interlaminar cervical ESI. After an uneventful C6-C7 ESI with triamcinolone, 1% lidocaine, and normal saline the patient developed singultus. Baclofen was sent to his pharmacy, but this was unsuccessful at alleviating his hiccups. The patient was subsequently started on chlorpromazine and found relief from his symptomatology.Conclusion Persistent hiccups after ESI or interventional pain procedures can be treated with conservative measures and non-pharmacologic methods, with escalation to therapy with baclofen, gabapentin, pregabalin, metoclopramide, chlorpromazine, other antipsychotic or antidopaminergic agents and possible dual or triple therapy if further indicated.