Arm Pain After Radiation Therapy
K. has been battling breast cancer for almost 20 years and so far its about a draw, but about 10 years ago she needed to have radiation therapy to an area of tumor recurrence in the R side of her neck. The treatment was successful, but years later she began to develop weakness in the arm followed by a burning numbness, which grew worse and worse. K. didn’t like the way narcotics made her feel and besides they didn’t relieve the pain anyway.
We told her that radiation neuritis was not uncommon after therapy to the brachial plexus and that we could probably help her. An initial cervical epidural steroid injection was effective for several months, but subsequent injections failed to give similar relief. We told her that her best option was an intrathecal pain pump, a fairly common procedure in our practice. Her pump would be a little different because in order to safely treat her arm the tip of the catheter would have to be fairly high up in her neck, not far from the base of her brain. This would increase the risks of insertion as well as the risks of drug toxicity. We told her that we had done this successfully on a number of previous occasions.
So far K. has done very well with about an 80% relief of pain. We continue to fine-tune the infusion mixture and drug doses. In addition K. now has a patient therapy manager, a device that allows her to give herself small amounts of extra medicine if she gets hit with a wave of pain. This approach to drug dosing helps insure that she will get adequate relief at all times without increasing the baseline dose when she doesn’t need it. The lower overall dose means fewer side effects.
We told her that radiation neuritis was not uncommon after therapy to the brachial plexus and that we could probably help her. An initial cervical epidural steroid injection was effective for several months, but subsequent injections failed to give similar relief. We told her that her best option was an intrathecal pain pump, a fairly common procedure in our practice. Her pump would be a little different because in order to safely treat her arm the tip of the catheter would have to be fairly high up in her neck, not far from the base of her brain. This would increase the risks of insertion as well as the risks of drug toxicity. We told her that we had done this successfully on a number of previous occasions.
So far K. has done very well with about an 80% relief of pain. We continue to fine-tune the infusion mixture and drug doses. In addition K. now has a patient therapy manager, a device that allows her to give herself small amounts of extra medicine if she gets hit with a wave of pain. This approach to drug dosing helps insure that she will get adequate relief at all times without increasing the baseline dose when she doesn’t need it. The lower overall dose means fewer side effects.