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Title: A Case Report: Management Of Pain In Terminal Stage Ca Buccal Mucosa, Post Chemotherapy And Radiotherapy With Neural And Muscular Interventions (Newer Safer Ultrasonography Guided Dry Needling - USDGN)
e-poster Number: INSIM95
Category: Pain
Author Name: Dr. Paras Anjaria
Institute: TNMC and BYL Nair Charitable Hospital
Co-Author Name: Dr. Varsha S Suryavanshi
Abstract :
Aim: To present a novel perspective of myofascial pathology as a cause of pain in cancer patient and to describe newer safer muscular interventional approach (USGDN) with neural interventions
Introduction: Oral cancer pain is a real challenge because of surgery, chemotherapy, radiotherapy and its complications 65 years male, pain VRS 9/10 over right scalp, face, neck, with restricted mouth opening, neck movements due to fibrosed muscles, stony hard Sternocleidomastoid, masseter, lateral pterygoid with dyspnea in supine. Method: Started with oral pregabalin, tramadol and myospaz. In view of difficult anatomy and fixed flexion deformity of neck first started USGDN of scalp, neck, facial muscles with 32G solid needles. Post 2 sessions, neck muscles partially relaxed, flexion deformity improved with accessible stellate anatomy. Stellate ganglion block and trigger injections given in fibrosed Sternocleidomastoid, masseter, lateral pterygoid.
Results: After 7 days VRS 5/10, continued with USGDN. Post 6 sessions, VRS 1-2/10 Improvement in neck tightness, movements with possible extension, absence of dyspnea in supine.
Discussion: Muscle relaxation with USGDN allowed to do neural interventions in this patient suggests that the intense muscle spasm led to the generation of myofascial trigger points in the face, head, neck and masticatory muscles causing pain with restricted movements. Placement of fine 32-gauge solid needles in involved muscle produces a local twitch reflex followed by intense muscle relaxation leading to pain relief due to release of nerve entrapments. Conclusion: Considering pain due to neuromyopathy, combined USGDN with neuro modulation proved to be effective in cancer pain and associated
