(ChemotherapyAdvisor) – Cervical pulsed radiofrequency (PRF) can be used as a palliative option for the treatment of severe chronic pain in patients with malignant breast cancer when conventional pain management does not provide adequate pain control, according to a presentation at the American Academy of Pain Medicine 28th Annual Meeting.
Investigators from University of Toronto, Toronto, Canada, reported two cases in which a 47-year-old female and a 67-year-old female were referred to the pain clinic. Despite multimodal analgesia by the palliative care team, both were experiencing severe, intractable pain, required increasing doses of narcotics, and were admitted to the hospital for adverse effects and pain management.
The first patient had pain primarily in her left arm associated with lymphedema due to involvement of the brachial plexus and was being managed with a CADD ambulatory infusion pump with hydromorphone (basal rate 1mg/hr; breakthrough 4mg q20min prn), methadone (10mg tid), and pregabalin (300mg bid).
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The second patient was readmitted 48 hours after discharge for a pain crisis for fever and cellulitis; she was delirious, in profound pain, and unable to tolerate skin contact to her left arm. On admission, her medications were CADD pump with hydromorphone (basal rate 3mg/hr; breakthrough 5mg) methadone (5mg tid), gabapentin (900mg tid), and dexamethasone (4mg q am).
Following treatment with unilateral cervical PRF rhizotomy of the left C5 and C6 dorsal root ganglion under fluoroscopic guidance, both patients experienced pain reduction; opioid use decreased by 60%. The first patient returned home eight days following the procedure and no longer required the CADD pump; the second patient returned home four days postprocedure with a significant reduction in CADD pump dose. At follow-up, both reported “dramatic improvement in pain control.”
PRF has been used to treat postamputation stump pain, visceral pain, neuropathic pain, headaches and, more recently, metastatic pain.
