title: Ultrasound-Guided Radiofrequency Treatment of Intercostal Nerves for the Prevention of Incidental Pain Arising Due to Rib Metastasis.
abstract: BACKGROUND
  Breakthrough pain (BTP) arising due to rib metastasis is very distressing and often very difficult to manage by titration of traditional analgesics. This study is undertaken to determine the efficacy of radiofrequency (RF) treatment of intercostal nerves for the prevention of BTP.
  
  
  METHODS
  The RF treatment of the intercostal nerves was carried out in 25 patients with uncontrolled BTP arising out of the rib metastasis. The intensity and episode of BTP, background pain, opioid dose, functional status (Karnofky score), and quality of life (Short-Form Health Survey [SF-36]) were noted at baseline visit and subsequently after the RF treatment.
  
  
  RESULTS
  After the RF treatment, there was more than 50% decrease in both intensity and frequency of BTP in more than 50% of patients for 3 months, and there was more than 50% decrease in BTP opioid dose in more than 50% of patients throughout the study period. There was also significant improvement in background pain, functional status, and the quality of life after the RF. Interestingly, pain relief, lowering of opioid dose, and functional status improvement were found mostly in patients with mixed and neuropathic type of pain and in patients in whom the metastasis were confined to the ribs only.
  
  
  CONCLUSIONS
  RF of the intercostal nerves is effective in preventing and deceasing the severity of BTP arising due to rib metastasis in selected group of patients with mixed and neuropathic type of pain and with the metastasis involving the ribs only.
authors.affiliation: 1 Department of Anesthesia, Pain and palliative care, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Arif
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: 1 Department of Anesthesia, Pain and palliative care, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sushma
authors.initials: S
authors.lastname: Bhatnagar
authors.affiliation: 1 Department of Anesthesia, Pain and palliative care, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepa
authors.initials: D
authors.lastname: Khurana
authors.affiliation: 1 Department of Anesthesia, Pain and palliative care, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Joshi
authors.affiliation: 2 Department of Radiology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
mesh_terms: D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary*; D059390:Breakthrough Pain / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D007367:Intercostal Nerves; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D012272:Ribs; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: breakthrough cancer pain; radiofrequency treatment