1. 2009;12;E277-E283Radiofrequency Treatment of the Thoracic Paravertebral Nerve Combined with Glucocorticoid for Refractory Neuropathic Pain Following Breast Cancer Surgery
   Case Report
   Ken-ichiro Uchida, MD.

BACKGROUND: Neuropathic pain following breast cancer surgery can have a profoundly negative impact on the physical and psychosocial functioning of patients. Radiofrequency treatment has been used as therapy for chronic pain, which also has a problem under debate of its neurodestructive nature. Although the efficacy and safety of using glucocorticoids in nerve block treatment are controversial, they have been used to treat neuropathic pain for many years and have been used to alleviate acute and continued postoperative pain. Neither radiofrequency combined with glucocorticoids nor radiofrequency treatment of the thoracic paravertebral nerve for neuropathic pain following breast cancer surgery has been reported.

OBJECTIVE: To describe the efficacy of thoracic paravertebral nerve radiofrequency treatment combined with glucocorticoids for refractory neuropathic pain following breast cancer surgery.

DESIGN: A series of 3 patients, who following breast cancer surgery with neuropathic pain that did not respond to conservative treatment, were selected. They received radiofrequency treatment of the thoracic paravertebral nerve combined with betamethasone. If pain remained after this treatment at a dermatome of a different level or at the same level, the same treatment was administered after at least 2 months had passed.

RESULTS: A total of 21 treatments were administered to the 3 patients. After these treatments, all 3 patients experienced pain relief and their quality of life improved as evaluated by the SF-36. Hypoesthesia worsened slightly after treatment. However, anesthesia dolorosa and transient burning pain in the corresponding dermatome, which seemed to be related to neuro-injury after radiofrequency treatment, were not seen.

CONCLUSION: This case series suggests that it is possible that radiofrequency treatment of the thoracic paravertebral nerve combined with glucocorticoid may help in pain relief and improve the quality of life of patients with refractory neuropathic pain following breast cancer surgery.