Interventional Pain Management for Sacroiliac Tumors in the Oncologic Population: A Case Series and Paradigm Approach.
Tumors invading the sacrum and/or ilium often represent incurable metastatic disease, and treatment is targeted toward palliation of symptoms and control of pain. As systemic opioid therapy is frequently inadequate and limited by side effects, a variety of interventional techniques are available to better optimize analgesia. Using six patients as a paradigm for interventional approaches to pain relief, we present a therapeutic algorithm for treating sacroiliac tumor-related pain in the oncologic population.



We describe the use of ultrasound-guided proximal sacroiliac joint corticosteroid injection, sacroiliac lateral branch radiofrequency ablation, percutaneous sacroplasty, and implantable neuraxial drug delivery devices to treat malignant sacroiliac pain in six patients. Pre- and postprocedure numerical rating scale (NRS) pain scores, duration of pain relief, and postprocedure pain medication requirements were studied for each patient.



Each patient had marked improvement in their pain based on an average postprocedure NRS difference of six points. The average duration of pain relief was eight months. In all cases, opioid requirements decreased after the intervention.



Depending on tumor location, burden of disease, and patient preference, patients suffering from metastatic disease to the sacrum may find benefit from use of ultrasound-guided proximal sacroiliac joint corticosteroid injection, sacroiliac lateral branch radiofrequency ablation, percutaneous sacroplasty, dorsal column stimulator leads, and/or implantable neuraxial drug delivery devices. We provide a paradigm for treatment in this patient population.
Department of Anesthesiology, Weill Medical College, Cornell University, New York, USA.
Nathan
N
Hutson
Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, U.S.A.
Joseph C
JC
Hung
Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, U.S.A.
Vinay
V
Puttanniah
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA.
Eric
E
Lis
Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Ilya
I
Laufer
Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, U.S.A.
Amitabh
A
Gulati
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000700:Analgesics / Q000008:administration & dosage*; D000072716:Cancer Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D004343:Drug Implants / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D012446:Sacroiliac Joint; D062187:Spinal Cord Stimulation / Q000379:methods; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D018084:Ultrasonography, Interventional / Q000379:methods
D000700:Analgesics; D004343:Drug Implants