title: Ritodrine for intractable uterine pain due to extrapelvic malignant tumor metastases: a case report.
abstract: BACKGROUND
  Effective pain management is an essential component of cancer treatment as approximately 75% of all cancer patients experience excruciating nociceptive pain even at maximum safe doses of nonsteroidal anti-inflammatory drugs and/or opioids. We report a case where ritodrine hydrochloride effectively controlled refractory pain due to uterine metastases from thymic carcinoma.
  
  
  METHODS
  A 40-year-old woman presented at our hospital with chest discomfort, severe right femoral pain, and intermittent hypogastralgia. Computed tomography, magnetic resonance imaging, and positron emission tomography revealed a large mass in the anterior mediastinum, multiple nodules in the lungs, and multiple metastases on the uterus, lumbar vertebrae, and pelvic bones. Needle biopsies of the mediastinal and uterine cervical tumors revealed undifferentiated carcinoma of the thymus metastasizing to the uterus. Oxycodone and nonsteroidal anti-inflammatory drugs relieved the right femoral pain but not the hypogastralgia. We speculated that hypogastralgia did not result from somatalgia but from splanchnodynia. Ritodrine was administered in an effort to inhibit uterine contractions and to reduced the refractory pain and improved her quality of life.
  
  
  CONCLUSIONS
  Ritodrine relieved the pain caused by uterine contraction due to metastases and enhanced the quality of life.
authors.affiliation: *National Hospital Organization, Kanagawa National Hospital, Pulmonary and Thoracic Surgery, Hadano, Kanagawa †Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yasoo
authors.initials: Y
authors.lastname: Sugiura
authors.forename: Etsuo
authors.initials: E
authors.lastname: Nemoto
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kadohira
authors.forename: Shizuka
authors.initials: S
authors.lastname: Kaseda
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D017699:Pelvic Pain / Q000150:complications / Q000188:drug therapy / Q000209:etiology; D012312:Ritodrine / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000209:etiology; D013566:Sympathomimetics / Q000627:therapeutic use*; D014594:Uterine Neoplasms / Q000150:complications* / Q000556:secondary*
chemical_list: D013566:Sympathomimetics; D012312:Ritodrine