Pain Management Techniques for Loin Pain Hematuria Syndrome Case Report

Background: Loin pain hematuria syndrome (LPHS) is a rare syndrome presenting with chronic unilateral or bilateral flank pain and gross or microscopic hematuria. Case Report: We present a case of LPHS in a male with past medical history of atrial fibrillation, Barrett’s esophagus, and loin pain hematuria syndrome who initially presented to our medical facility with gross hematuria, intractable left flank pain, and non-bloody emesis. Our case exemplifies the challenge in managing patients with LPHS. Conclusion: Without a definitive mechanism for LPHS, current treatment focuses on symptom management. Analgesics (non-opioid and opioid) may be used orally or intravenous depending on the presence of concomitant nausea and vomiting. For patients at risk of opioid dependence, targeting afferent pain fibers originating from the kidneys and ureters has proven a successful analgesic strategy. Surgical options for renal denervation include: endovascular radiofrequency ablation, laparoscopic renal denervation, and renal auto transplant. Treatment options for this disease process include intra-ureteric bupivacaine, renal denervation, and possible spinal cord stimulation. Key words: Flank pain, loin pain hematuria syndrome, renal denervation, spinal cord stimulation