Lumbar sympathetic block for managing phantom limb pain in a squamous cell carcinoma patient post

hemipelvectomy: a case report

Abstract ID: 2162751

Abstract Category: Scientific Abstracts

Abstract Status: Complete / Locked

Author(s)

Abby Niles G. Cuenco, MD, CFP (he/him/his)

Role: Submitting Author

Maria Lourdes Josefina Cabaluna, MD, DPBPM (she/her/hers)

Role: Co-Author

Karmi Margaret Marcial, MD, DPBPM (she/her/hers)

Role: Co-Author

Abstract

Topic

Chronic Pain

Introduction

This case report details the successful management of phantom limb pain (PLP) in a 44-year-old female with persistent

phantom limb pain post hemipelvectomy due to recurrent cervical squamous cell carcinoma. The patient presented with

complications from her cancer treatment and pre-existing phantom limb pain, initially managed with a fentanyl PCA pump.

Eventually, C-ARM guided lumbar sympathetic block was administered, providing significant pain relief and improved quality of life.

Materials and Methods

Patient presented with three-year history of phantom limb pain on the lower back and hips radiating to the lower extremities.

She was assessed using the Numerical Rating Scale (NRS) and the American Chronic Pain Association Quality of Life Scale (ACPA-

QOLS) at baseline with regular intervals during treatment. Interventional pain management was eventually offered as outpatient

procedure to provide better pain relief and improved quality of life.

Patient's informed consent for case report was signed.

Case report is devoid of patient identifiable information, thereby exempted from IRB review requirements per St. Luke's

Medical Center - Global City policy.

At the outpatient operating room, patient put on prone position. Aseptic technique was done. C-arm identified bilateral lesions

(metastatic tumors) at L2-L3 confirmed with dye uptake. A 10-milliliter solution containing Bupivacaine 0.25% and

methylprednisolone 20mg were administered at the bilateral lower endplates of the L2 vertebral bodies using gauge 22 needle.

Results/Case Report

Immediately after the lumbar sympathetic block, the patient’s pain score improved to 0-2 from baseline of 3-4. No

complications were noted. Patient was sent home fully awake with stable vital signs. She was discharged improved.

Upon follow-up after two weeks, the patient’s pain scores for her phantom limb pain have diminished to NRS 3/10. American

Chronic Pain Association Quality of Life Score is now 5/10 from 1/10 prior to intervention. She was able to rest at the comfort of her

own home. She proceeded to continue with her company work.

Discussion

This case shows that lumbar sympathetic block is an effective option to manage persistent phantom limb pain. This suggests

that the sympathetic nervous system plays a role in phantom limb pain. Lumbar sympathetic block can be used as part of a

multidisciplinary biopsychosocial approach to pain relief.

References

· American Chronic Pain Association. (n.d.). About us [Web page]. Retrieved February 13, 2025, from https://www.acpanow.com/

· Amputee Coalition. (n.d.). Managing Phantom Pain. Retrieved from https://amputee-coalition.org/limb-loss-resource-center/resources-for-pain-

management/managing-phantom-pain/

· BMJ J Neurol Neurosurg Psychiatry: Making sense of phantom limb pain - https://jnnp.bmj.com/content/93/8/833

· PMC: Phantom Limb Pain: Mechanisms and Treatment Approaches - https://pmc.ncbi.nlm.nih.gov/articles/PMC3198614/

· Nikolajsen, L., & Jensen, T. S. (2001). Phantom limb pain: A review of the literature on pharmacological treatment options—part II: Mechanisms-

based treatments and future directions for research studies on phantom limb pain treatment modalities including mirror box therapy and

transcranial magnetic stimulation techniques as well as other non-pharmacological interventions like cognitive behavioral therapy which may

also be beneficial in managing chronic neuropathic conditions such as PLP post-amputation surgeries. Journal of Pain Research, 4, 93–104.