title: Post-dural puncture thoracic pain without headache: relief with epidural blood patch.
abstract: We report two unusual cases of postural, post-dural puncture upper thoracic interscapular backache, without headache, that were relieved by epidural blood patching. There is controversy concerning the aetiology of headache associated with the post-dural puncture syndrome. Mechanisms previously proposed have included traction on pain-sensitive intracranial structures such as the dura or blood vessels, or a vascular mechanism which may be adenosine-receptor mediated. These two cases suggest that traction on cervical or upper thoracic nerve roots should be considered as a possible mechanism of pain in the post-dural puncture syndrome.
authors.affiliation: Department of Anesthesia and Pain Clinic, Brigham and Women's Hospital, Boston, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Dunbar
authors.forename: N P
authors.initials: NP
authors.lastname: Katz
mesh_terms: D001416:Back Pain / Q000209:etiology* / Q000628:therapy*; D017217:Blood Patch, Epidural; D004244:Dizziness / Q000209:etiology; D004388:Dura Mater; D005260:Female; D005500:Follow-Up Studies; D006261:Headache; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D011187:Posture; D013129:Spinal Puncture / Q000009:adverse effects*; D013900:Thoracic Nerves / Q000293:injuries