title: Pain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy.
abstract: Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. The pain is difficult to control because it is a mixture of nociceptive and neuropathic pain, which indicates that treatment requires a versatile approach. The authors report a case of severe back pain caused by metastasis to the psoas muscle of advanced gastric cancer in a patient who underwent palliative radiotherapy under epidural analgesia. Despite conventional analgesics and subcutaneous oxycodone, he had difficulties in maintaining supine position because of the back pain and had a problem to receive radiotherapy, which required him to stay still in the same position during the treatment. By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.
authors.forename: Takayo
authors.initials: T
authors.lastname: Ota
authors.forename: Masaru
authors.initials: M
authors.lastname: Makihara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsukuda
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kajikawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Inamori
authors.forename: Nozomi
authors.initials: N
authors.lastname: Miyatake
authors.forename: Noriko
authors.initials: N
authors.lastname: Tanaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Takuhito
authors.initials: T
authors.lastname: Tada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fukuoka
mesh_terms: D015360:Analgesia, Epidural; D006801:Humans; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000150:complications / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010148:Intractable Pain / Q000150:complications / Q000188:drug therapy*; D010166:Palliative Care; D013274:Stomach Neoplasms / Q000150:complications / Q000532:radiotherapy*; D013577:Syndrome
keywords: epidural analgesia; malignant psoas syndrome; pain; palliative radiotherapy