Spinal cord stimulation alleviates intractable pain due to malignant pleural mesothelioma: a case report

Our plain-English summary of Spinal cord stimulation alleviates intractable pain due to malignant pleural mesothelioma: a case report, by A. Maeda, M. Watanabe, C. Saigano, et al (JA Clinical Reports, 2020).

The study

• Authors: A. Maeda, M. Watanabe, C. Saigano, S. Nakayama, K. Yamaura
• Journal: JA Clinical Reports
• Published: 2020;6(1):78
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Patients with malignant pleural mesothelioma (MPM) frequently complain of intractable pain that is resistant to conservative treatments. Although spinal cord stimulation (SCS) may be promising in the alleviation of such devastating pain, the effects of SCS on MPM-associated pain and the appropriate timing of its application remain unknown.

Case Presentation: A 66-year-old man diagnosed with MPM presented with severe neuropathic pain due to rapid progression of the tumor to the intercostal nerves. The patient immediately decided to receive SCS implantation and burst stimulus, which relieved the conservative therapy-resistant pain and improved his sleep and daily activities.

Conclusion: This report suggests that the execution of SCS as soon as possible may help to alleviate MPM symptoms. Since MPM extends aggressively to the thorax and nerves that cause mixed nociceptive and/or neuropathic pain, appropriate pain management requires the proper assessment of the etiology by an expert in pain management.

In plain English

This case report described one 66-year-old man in Japan with a history of occupational asbestos exposure (fiber type not stated) and stage IV sarcomatoid malignant pleural mesothelioma. His chest pain returned and did not respond to several medicines, including oxycodone at approximately 320 mg total oral morphine equivalents. His doctors judged that tumor spreading into the nerves between the ribs had added nerve-related pain. They placed spinal cord stimulation electrodes. In a 7-day trial, a 'burst' stimulation pattern worked better for him than tonic stimulation. His pain score fell from 8 to 4 on a 0 to 10 scale, and a permanent device was implanted. He reported more daily activity and less sleep disturbance, and his oxycodone dropped to approximately 180 mg oral morphine equivalents. When the pain spread a month later, electrode sites were changed, and relief lasted for his remaining eight months of life. The authors concluded that implanting spinal cord stimulation as quickly as possible may improve symptoms, and they recommended further studies. A single-patient report cannot show how often this works.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 66-year-old man with sarcomatoid malignant pleural mesothelioma (T4 N0 M0, stage IV) in the left pleura, treated at Kyushu University Hospital, Fukuoka, Japan; published 2020
• Exposure: History of occupational asbestos exposure; the fiber type, job and dose are not described. The treatment studied was spinal cord stimulation (burst stimulation).
• Main results:
  • Before spinal cord stimulation, the patient's maximum pain was 8 on a 0 to 10 numerical rating scale
  • In the patient's 7-day trial, burst stimulation worked better for him than tonic stimulation
  • After the trial, the patient's pain intensity improved from 8 to 4 on the numerical rating scale, and a permanent pulse generator was implanted
  • The patient reported more daily activity and less sleep disturbance
  • The patient's oxycodone intake fell from approximately 320 mg to approximately 180 mg total oral morphine equivalents
  • About a month after implantation, the patient's pain spread. Electrode sites were changed, and pain relief lasted for his remaining eight months of life.
• The authors' conclusion: The authors concluded that spinal cord stimulation relieved this patient's treatment-resistant neuropathic pain. They concluded that when a pain specialist finds intractable neuropathic pain in a patient with MPM, implanting spinal cord stimulation as quickly as possible may improve symptoms.
• Limitations the authors state:
  • The authors noted that clinical evidence for spinal cord stimulation in cancer pain is still lacking
  • The authors called for further studies of how well spinal cord stimulation works for MPM-associated neuropathic pain

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Thorax, Etiology.

Related studies

• Clinical presentation of asbestosis with intractable pleural pain in the adult child of a taconite miner and radiographic demonstration of the probable pathology causing the pain — M.R. Harbut, C. Endress, et al. (2009)
• Intradural intramedullary spinal cord metastasis due to mesothelioma — M.C. Chamberlain, K.D. Eaton, et al. (2010)
• Extensive epidural cufflike growth of malignant pleural mesothelioma causing spinal cord compression — J.M. Gijtenbeek, H.I. Brouwer, et al. (2002)
• Sarcomatoid malignant mesothelioma presenting with intramedullary spinal cord metastasis: a case report and literature review — J. Yamamoto, K. Ueta, et al. (2014)
• Intramedullary Metastasis to the Cervical Spinal Cord from Malignant Pleural Mesothelioma: Review of the Literature and Case Reports — F. Kalfas, C. Scudieri (2020)
• Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy — K. Ural, K. Jakob, et al. (2014)

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