22nd Annual Pain Medicine Meeting 2023

Intercostal neuralgia is a painful condition characterized by sharp, shooting, or burning pain along the distribution of an intercostal nerve
Most commonly presents after thoracotomies, breast surgeries, nerve entrapment, neuromas, or with herpes zoster
Conventional therapies include NSAID’s, neuropathic, narcotics, and intercostal nerve blocks
Case reports have demonstrated that radiofrequency ablations (RFA) can provide benefit to patients refractory to conventional treatments
64 year old man presents with chronic right sided rib pain secondary to lung adenocarcinoma treated with radiation therapy
At initial evaluation, patient was taking 100 mcg/hr fentanyl transdermal patches every three days, daily dose of 40 mg of oxycodone/acetaminophen, and gabapentin 300 mg TID
Initially responded favorably to intercostal nerve blocks from T7 to T9 with 0.25% bupivicaine and triamcinolone for several months
Repeat intercostal nerve blocks provided smaller durations of relief for patient
Thermal RFA was then performed at the T7-9 levels on the right side
RFA provided long lasting relief which is currently ongoing
Patient was able to reduce opioid consumption to just 37.5/hr mcg fentanyl patch with complete cessation of his oxycodone/acetaminophen
Case demonstrates another potential use of RFA in non-axial pain states
Literature review up to date has demonstrated at least 14 applications of intercostal RFA with positive and durable outcomes for patients
Prior case reports predominantly present patients with intercostal neuralgia secondary to surgical sequelae as opposed to radiation or neoplastic induced intercostal neuralgia
Intercostal RFA was crucial in regards to reducing patients opioid dose from 300 morphine milligram equivalents (MME)/day to 90 MME/day
Further large scale studies are warranted to further elucidate and define the overall benefits, risks, and potential sequelae of this procedure

22nd Annual Pain Medicine Meeting 2023

INTERCOSTAL RADIOFREQUENCY ABLATIONS: A PROMISING THERAPY FOR REFRACTORY INTERCOSTAL NEURALGIA

Poster Presenter

Authors

Affiliations

Part of Topic