Abstract ID: A31
Abstract Title: Myofascial pain syndrome: Overlooking syndrome in cancer patients
Poster Type: Either
ABSTRACT BODY
Myofascial pain can mimic several pain symptoms and often misled to wrong diagnosis and management. Report of three cases of myofascial pain which was misdiagnosed for cancer pain.
Case 1: 45 years old caucasian female presented to pain clinic for intractable abdominal pain. She was recently diagnosed of adenocarcinoma of pancrease after diagnostic laparoscopic examination with tumor biopsy. Since 2 week after procedure,she experienced dull aching pain over epigastrium which radiated to over abdomen. No correlation with ingestion or activity was found related to her pain. She was diagnosed cancer pain from carcinoma of pancrease, and received treatment with Durogesic® patch for pain relief. The dose gradully increased over 2 weeks from 25 to 150 microgram/hour patches. Despite the adverse effect of nausea and occasional vomiting, she did not experience adequate pain relief. Upon examination, the trigger spot was found at right external oblique, which reproduced her pain. Trigger point injection with 0.25 % bupivacaine every other day for 1 weeks followed with stretching excercise of this muscle provided excellent pain relief. She was weaned off the durogesic® patch and remained pain free up to 9 months follow up.
Case 2: 62 years old asian male who had constant dull aching pain with occasional sharp shooting pain at right frank for 6 months after right hepatectomy. He was diagnosed of neuropathic pain from nerve injury, and received treatment with various medication including oral morphine 100 mg per day. Trigger point was found at right quadratus lumborum. Regimen of trigger point injection-stretching excercise was applied. Within 2 weeks he was off all medication. He continued with stretching excercise. Follow up 2 months later, he was pain free and doing well.
Case 3: 49 years old asian female, who was diagnosed for cervical carcinoma, presented with 2 months of sharp,shooting pain from back to right groin and medial thigh. Eight months ago she received pelvic radiation for cervical cancer treatment. Magnetic resonance and computerized scan revealed no evidence of disease progression. Trial of right psoas trigger point injection with 0.25 % marcaine 5 cc yield immediate pain relief. She was then starting on stretching excercise program to recondition psoas muscle. Follow up at 4 months, she was doing well with complete pain relief. She was off all medication and went back to work.
These three cases are just the example of how myofascial pain can misdiagnosed to other pain syndrome. Inappropriate management from misdiagnosis is not only unable to acheive pain relief, but creates adverse reaction as well. Clinicians should be on alert for possibility of this phenomenon even in the case of obvious cause for other pain syndrome.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A31