A Case Where the Epidural Block Was Useful for the Differential Diagnosis of Low Back Pain in a Patient with Esophageal Cancer and Lumbar Disc Herniation
- VernacularTitle:食道がんに伴うがん性疼痛および腰椎椎間板ヘルニア併発患者の腰背部痛の鑑別に硬膜外ブロックが有用であった1症例
- Author:
Yasuhiro KOJIMA
1
;
Masahito MURAMATSU
2
Author Information
- Keywords: cancer pain; chronic non-cancer pain; splanchnic nerve block; lumbar disc herniation
- From:Palliative Care Research 2023;18(4):241-245
- CountryJapan
- Language:Japanese
- Abstract: Introduction: We experienced a case in which an epidural block was useful in estimating the cause of low back pain in a patient suffering from esophageal cancer with liver and paraaortic lymph node metastases. Case: A 69-year-old male with a history of surgery for lumbar disc herniation (at the age of 20). He was diagnosed with esophageal cancer and during follow-up, he noticed low back pain, followed by epigastric pain. MRI revealed L1/2 and L2/3 intervertebral disc herniation. The thoracic epidural block was performed from Th8/9 under X-ray fluoroscopy to alleviate symptoms and identify the cause of low back pain. After confirming the analgesic effect, we conducted a splanchnic nerve block using neurolytic agent (anhydrous ethanol), resulting in total pain elimination. Subsequently, the patient passed away under good pain control without increasing the dose of analgesics. Conclusion: By confirming the effectiveness of epidural block at the thoracic level in advance, the complicated pain was thought to be derived from not lumber disc herniation, but the visceral nerves. An epidural block was useful for the selection of subsequent analgesic therapy.
