scholarly journals Quadratus Lumborum Block for Back Pain Related to Pancreatic Cancer – A Report of Two Cases

2018 ◽  
pp. 197-203
Author(s):  
Uri Hochberg
Keyword(s):  
Pancreatic Cancer ◽  
Back Pain ◽  
Pain Management ◽  
Pain Relief ◽  
Cancer Pain ◽  
Myofascial Pain ◽  
Celiac Plexus ◽  
World Health ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum

Pancreatic cancer is often accompanied by severe pain. Patients typically experience upper abdominal and/or thoracolumbar back pain. For those cases failing to respond to standard medical management, as suggested by the World Health Organization, interventions designated at interruption of the sympathetic axis (such as neurolysis of the celiac plexus or splanchnic nerves) have been shown to be efficacious. Other than axial drug delivery, there are few interventional alternatives in patients with pancreatic cancerrelated pain. There is little knowledge regarding the therapeutic effects of treating peripheral somatic soft tissue among oncological patients. Here we report on 2 such patients, whose back pain improved following a quadratus lumborum block. Two patients diagnosed with pancreatic cancer presented with severe back pain. The pain pattern and patients’ physical exams were compatible with myofascial pain arising from the quadratus lumborum muscle, possibly irritated by the abdominal tumor. Advanced pain management, including long- and short-acting opioids and adjuvants, as well as celiac plexus neurolytic block, failed to provide satisfactory pain relief. Given the apparent muscular origin of the pain, a bilateral ultrasound-guided quadratus lumborum block was performed. Four weeks post procedure, the 2 patients reported substantial pain relief supported by reduced consumption of pain medication and improved functional status. No adverse events or complications were observed in either case. In the patients described here, quadratus lumborum block proved to be safe and efficacious in alleviating back pain related to pancreatic cancer. In our opinion, clinicians should be aware of the possible contribution of a myofascial component to pain in pancreatic cancer and in cancer-related pain in general. Key words: Quadratus lumborum block, cancer pain, pancreatic cancer, pain control, myofascial pain syndrome, interventional pain management

1998 Labat Lecture: The Role of the Neurolytic Celiac Plexus Block in Pancreatic Cancer Pain Management:

1998 ◽  
Vol 23 (6) ◽  
pp. 611-614
Author(s):  
Stefano Ischia ◽  
Enrico Polati ◽  
Gabriele Finco ◽  
Leonardo Gottin ◽  
Barbara Benedini
Keyword(s):  
Pancreatic Cancer ◽  
Pain Management ◽  
Cancer Pain ◽  
Celiac Plexus ◽  
Celiac Plexus Block ◽  
Cancer Pain Management ◽  
Plexus Block

scholarly journals Atraumatic Back Pain Due to Quadratus Lumborum Spasm Treated by Physical Therapy with Manual Trigger Point Therapy in the Emergency Department

2019 ◽  
Vol 3 (3) ◽  
pp. 259-261 ◽  
Author(s):  
Casey Grover ◽  
Kory Christoffersen ◽  
Lindsay Clark ◽  
Reb Close ◽  
Stephanie Layhe
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Physical Therapy ◽  
Pain Relief ◽  
Myofascial Pain ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Trigger Point ◽  
Quadratus Lumborum ◽  
Trigger Point Therapy

Manual trigger point therapy is effective for treating myofascial pain, yet it is not frequently used in emergency department (ED) settings. A 42-year-old female presented to the ED with atraumatic back pain. Her pain was thought to be myofascial, and we obtained a physical therapy consultation. Diagnosing the patient with quadratus lumborum spasm, the physical therapist treated her in the ED using manual trigger point therapy, and completely relieved her pain without requiring any medications. Manual trigger point therapy can provide non-opioid pain relief in ED patients, and physical therapists can apply this technique effectively in the ED.

Cancer pain management

2014 ◽  
Vol 155 (3) ◽  
pp. 93-99
Author(s):  
Péter Heigl
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Pain Relief ◽  
Life Expectancy ◽  
Cancer Pain ◽  
Cancer Pain Management ◽  
Medical Activity ◽  
Short Summary ◽  
Adequate Quality

Pain is a significant and alarming symptom of cancer seriously affecting the activity and quality of life of patients. Recent research proved that inadequate analgesia shortens life expectancy. Therefore, pain relief is not only a possibility but a professional, ethical and moral commitment to relieve patients from suffering, as well as ensure their adequate quality of life and human dignity. Proper pain relief can be achieved with medical therapy in most of the cases and the pharmacological alternatives are available in Hungary. Yet medical activity regarding pain relief is far from the desired. This paper gives a short summary of the guidelines on medical pain management focusing particularly on the use of opioids. Orv. Hetil., 2014, 155(3), 93–99.

A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain

2001 ◽  
Vol 54 (3) ◽  
pp. 316-324 ◽  
Author(s):  
Naresh T. Gunaratnam ◽  
Aruna V. Sarma ◽  
Ian D. Norton ◽  
Maurits J. Wiersema
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Pain ◽  
Prospective Study ◽  
Celiac Plexus ◽  
A Prospective Study

scholarly journals Transdermal buprenorphine in cancer pain and palliative care

2006 ◽  
Vol 20 (8_suppl) ◽  
pp. 25-30
Author(s):  
Reinhard Sittl
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Rescue Therapy ◽  
The Elderly ◽  
World Health ◽  
Prolonged Treatment ◽  
Postmarketing Surveillance ◽  
Efficacy And Safety ◽  
Good Tolerability

Transdermal buprenorphine has been assessed as a therapy for chronic cancer and non-cancer pain in both clinical and postmarketing surveillance studies. Data from 239 patients who had participated in a follow-up study of up to six years have shown efficacy and safety, and good tolerability over prolonged treatment periods with a marked stability of doses. From the cancer pain population (134 patients), 20% stayed on transdermal buprenorphine until the end of their lives. Postmarketing surveillance study data from 13 179 patients, including 3690 cancer patients assessed during a 10-week observation period, showed that 81% of patients achieved good/very good pain relief with transdermal buprenorphine. Furthermore, 49.6% of patients did not require any analgesic comedication or rescue therapy, a point that is particularly important in the elderly population. Results from the Spanish Pain Society on transdermal buprenorphine in chronic non-cancer, neuropathic and cancer-related pain, and on switching from morphine, also confirmed its beneficial efficacy and safety, and showed that buprenorphine does not antagonize pain relief, or cause withdrawal when combined with full μ-agonists. The effectiveness of buprenorphine is further supported by evidence of its pronounced anti-hyperalgesic effect in a human pain model, which may be a factor in explaining the efficacy of buprenorphine in neuropathic pain. When switching of opioids is indicated to improve pain relief or reduce adverse events, equipotency dosage ratios are important. The equipotency ratio for morphine to buprenorphine, previously established as 75:1, is now being questioned as new data from a retrospective cohort study were published indicating a ratio of 100:1. Moreover, transdermal buprenorphine has superior safety in respect to respiratory depression, immunological and renal effects compared with standard World Health Organization step III opioids, which makes it highly suitable for treating moderate-to-severe pain also in cancer patients, a per se vulnerable patient population requiring a sensible selection of potent analgesics.

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