Dr. Abby Niles Cuenco Conference 2025 - Pub Scholars

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Abstract Title: - Lumbar sympathetic block as adjunct to management of phantom limb pain in a patient with recurrent squamous cell carcinoma post hemipelvectomy: a case report

Keynote Speaker - Dr. Abby Niles Cuenco - Oral Poster Presentation

MD, Pain Management Center, St. Lukes’s Medical Center – Global City, Taguig City, Metro Manila, Philippines

Abstract:

Objectives: This case report details the successful management of phantom limb pain (PLP) in a 44-year-old female with persistent phantom limb pain post hemipelvectomy due to recurrent cervical squamous cell carcinoma. The patient presented with complications from her cancer treatment and pre-existing phantom limb pain, initially managed with a fentanyl PCA pump. Eventually, C-ARM-guided lumbar sympathetic block was administered, providing significant pain relief and improved quality of life.

This study aims to (1) assess and manage the patient's phantom limb pain, including its intensity, characteristics (e.g., burning, stabbing), and impact on quality of life, and (2) evaluate and highlight the

Methods:

The patient presented with a three-year history of phantom limb pain on the lower back and hips radiating to the lower extremities. She was assessed using the Numerical Rating Scale (NRS) and the American Chronic Pain Association Quality of Life Scale (ACPA-QOLS) at baseline with regular intervals during treatment. Interventional pain management was eventually offered as an outpatient procedure to provide better pain relief and improved quality of life.

At the outpatient operating room, patient put on prone position. Aseptic technique was done. C-arm identified bilateral lesions (metastatic tumors) at L2-L3 were confirmed with dye uptake. A 10-milliliter solution containing Bupivacaine 0.25% and methylprednisolone 20mg were administered at the bilateral lower endplates of the L2 vertebral bodies using gauge 22 needle.

Results:

Immediately after the LSB, patient’s pain score improved to 0-2 from BASELINE of 3-4. No complications were noted. Patient was sent home fully awake with stable vital signs. She was discharged improved.

Upon follow-up after two weeks, the patient’s pain scores for her PLP have diminished to NRS 3/10. ACPA Quality of Life Score is now 5/10 from 1/10 prior to intervention. She was able to rest at the comfort of her own home. She proceeded to continue with her company work.

Conclusions :

This case shows that lumbar sympathetic block is an effective option to manage persistent phantom limb pain. This suggests that the sympathetic nervous system plays a role in PLP. LSB can be used as part of a multidisciplinary biopsychosocial approach to pain relief.

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