Supplementary FCO 2024

Introduction: Pain caused by metastatic osteolytic lesions can be intense and difficult to manage.In most cases, treatment includes opioids and other analgesics with many unpleasant side effects. Aim:The purpose of this case report is to highlight that peripheral nerve neuromodulation can be applied regionally with excellent results, and therefore represents an additional option in the management of bone and neuropathic pain. Methods:A 68-year-old hairdresser, was diagnosed in 2019 with stage IIIa non-small cell lung cancer.The patient received preoperative chemotherapy (Cisplatin/Gemcitabine) and underwent a right upper lobectomy.He completed adjuvant chemotherapy and remained disease-free for 10 months.Subsequent staging revealed disease relapse in the lung, muscles and bones and he was commenced on 2 nd line chemotherapy (Carboplatin/Alimta) in combination with immunotherapy (Pembrolizumab).Treatment was discontinued after 8 cycles following a diagnosis of complex mononeuritis which had significant impact in his quality of life and ability to work.He experienced left humeral pain (intensity VAS 6-8/10) that did not improve despite the use of Tramadol 400mg/d, Fentanyl patch 37/h, Paracetamol 4gr/d, Pregabalin 600mg/d, and was resistant to prolonged maximum corticosteroid therapy (p.o and iv) in combination with Rituximab.Furthermore, pain related to a left humeral fracture did not respond to palliative radiotherapy.At this point, the decision was made to attempt neuromodulation of the musculocutaneous and radial nerve.This was applied under local anesthesia and aseptia on either side of the fracture, with pulsed radiofrequency at 40C for 10 minutes. Results:An initial pain reduction of 3 VAS units (3-5/10) was observed.After 14 days he had improved arm movement, minimal residual pain and opioid weening began.Importantly, the procedure had no effect on sensory innervation and the patient was able to return to work.Conclusions: Peripheral nerve neuromodulation is an effective and safe invasive analgesic procedure that treating physicians must be aware of, in order to ensure a timely referral to an interventional pain physician when standard therapies have failed.