Disclosures: Thomas Chai, MD: No financial relationships or conflicts of interest

Case Diagnosis: Cancer-related pain/neuralgia

Case Description: The patient is a 41 year old female with oncologic history of left pelvic spindle cell sarcoma of the sciatic notch, refractory to conservative management. The patient underwent surgical resection of the pelvic tumor, with subsequent imaging demonstrating residual disease. Over the next five years, she experienced progressively worsening, debilitating sciatic neuralgia, despite stable imaging and treatment to include physical therapy, aggressive pharmacotherapy, and pain procedures, such as sacroiliac joint injections, lumbar epidural injections, and piriformis injections. At this point, it was thought that the patient would benefit from neurostimulation. The patient underwent a trial of dorsal column stimulation, with electrodes placed at the T8/T9 vertebral level.

Setting: Tertiary care cancer hospitalAssessment/

Results: The patient reported resolution of her sciatic neuralgia pain with use of the SCS, and subsequently underwent permanent spinal cord stimulator implantation. She was then able successfully to return to work.

Discussion: Neurostimulation, in particular spinal cord stimulation (SCS), is a method whereby electrodes are placed in the posterior epidural space to stimulate the dorsal columns of the spinal cord, which results in relief of pain, in part, by way of the gate-control theory. SCS has been demonstrated to alleviate a variety of painful non-malignant conditions, which includes failed back surgery syndrome, complex regional pain syndrome, peripheral vascular disease pain, and angina, among other conditions. There exists less robust evidence in the literature for neurostimulation in the management of cancer-related pain. The results of our case support the consideration of SCS for relieving refractory peripheral nerve pain due to malignancy.

Conclusion: Neurostimulation should be considered for the management of cancer-related peripheral neuralgias, refractory to standard, conservative therapy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/refractory-sciatic-neuralgia-due-to-pelvic-sarcoma-relieved-with-neurostimulation-a-case-report/