title: Management of chronic pain in a patient with autosomal dominant polycystic kidney disease by sequential celiac plexus blockade, radiofrequency ablation, and spinal cord stimulation.
abstract: Chronic pain frequently is associated with autosomal dominant polycystic kidney disease and is a significant cause of morbidity. The classic approach to treat pain in patients with this disease starts with nonpharmacologic therapy and progresses to high-dose opioid therapy and more invasive procedures, including surgery. We present the case of a 43-year-old white woman presenting in our clinic with poorly controlled chronic left flank and epigastric pain secondary to autosomal dominant polycystic kidney disease despite high-dose opioids and multiple cyst decompression procedures. After temporarily successful management with celiac plexus neurolysis and intercostal nerve radiofrequency ablations for years, the next more permanent step was dorsal column neurostimulation, affording excellent analgesia with significantly improved quality of life to this day.
authors.affiliation: University of South Florida College of Medicine, Tampa, FL.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Walsh
authors.forename: Jose E
authors.initials: JE
authors.lastname: Sarria
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D002447:Celiac Plexus; D059350:Chronic Pain / Q000150:complications / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D013116:Spinal Cord; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome