Pain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy

Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several...

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Bibliographic Details
Published in:Journal of pain & palliative care pharmacotherapy 2017-04, Vol.31 (2), p.154-157
Main Authors: Ota, Takayo, Makihara, Masaru, Tsukuda, Hiroshi, Kajikawa, Ryuji, Inamori, Masayuki, Miyatake, Nozomi, Tanaka, Noriko, Tokunaga, Masahiro, Hasegawa, Yoshikazu, Tada, Takuhito, Fukuoka, Masahiro
Format: Article
Language:English
Subjects:
Analgesia, Epidural
Humans
Male
Middle Aged
Neurodegenerative Diseases - complications
Neurodegenerative Diseases - drug therapy
Pain Management - methods
Pain, Intractable - complications
Pain, Intractable - drug therapy
Palliative Care
Stomach Neoplasms - complications
Stomach Neoplasms - radiotherapy
Syndrome
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Summary:Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. The pain is difficult to control because it is a mixture of nociceptive and neuropathic pain, which indicates that treatment requires a versatile approach. The authors report a case of severe back pain caused by metastasis to the psoas muscle of advanced gastric cancer in a patient who underwent palliative radiotherapy under epidural analgesia. Despite conventional analgesics and subcutaneous oxycodone, he had difficulties in maintaining supine position because of the back pain and had a problem to receive radiotherapy, which required him to stay still in the same position during the treatment. By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.
ISSN:1536-0288
1536-0539
DOI:10.1080/15360288.2017.1301617