Presented at the 2012 AAPM Annual Meeting « Back

Cervical Pulsed Radiofrequency for Metastatic Breast Cancer Involving the Brachial Plexus

Ben-Ari Fried, MD, ben-ari.fried@sunnybrook.ca¹, Arsenio J. Avila, MD FRCPC², Gil Faclier, MD FRCPC¹, (1) Anesthesia, Pain Management Clinic, Toronto, Ontario, Canada, (2) University of Toronto, University of Ottawa and Northern Ontario School of Medicine, Toronto, Ontario, Canada

Introduction: Malignant disease, and specifically malignant metastases, are often associated with severe chronic pain. While commonly managed with a multimodal analgesic approach, the progressive nature of the disease often requires increasing doses of analgesics, specifically opioid type narcotics, which can increase side effects, significantly impacting quality of life (QoL). This will often require admission to a hospital where patients will sometimes spend their final weeks or months of life. Interventional pain management has been gaining increasing interest as an alternative treatment to reduce pain and opioid use and improve QoL. We present two such cases. Materials and Methods: Two patients with metastatic breast cancer involving the brachial plexus were referred to our pain clinic within the last 6 months. Patient A is a 47-year-old female, and Patient B is a 67-year-old female. Both were experiencing severe, intractable pain despite management with multimodal analgesia by the palliative care team. Both women required increasing doses of narcotics and were admitted to hospital for side effects and pain management. Both were treated with unilateral cervical pulsed radiofrequency (PRF) under fluoroscopic guidance. Results: Following the intervention, both patients experienced a reduction in pain and were using less opioid (>60% decrease) and were discharged shortly after the intervention as their pain became more manageable. Conclusions: Interventional management of cancer pain should be considered when conventional pain management does not provide adequate pain control. While complex in some cases and not always feasible, it can sometimes reduce pain and opioid use and improve QoL.

Funding: None