Effect of Radiofrequency Thermocoagulation of Thoracic Nerve Roots in Patients with Cancer and Intractable Chest Wall Pain

Abstract

Background: Interventional pain management is essential for patients with cancer who experience medically uncontrollable chest wall pain to help control their symptoms and improve their quality of life. However, there is a lack of data on this topic, so there is an urgent need for further research. Objectives: To identify the effects of radiofrequency ablation (RFA) of the thoracic nerve roots on pain outcomes in patients with cancer and intractable chest wall pain. Study Design: Retrospective, observational cohort study. Setting: National Cancer Center in Korea. Methods: The medical records of patients with cancer who were referred to the pain clinic at our National Cancer Center for intractable chest wall pain and who underwent thoracic nerve root RFA between Jan. 1, 2011 and Dec. 31, 2015 were analyzed. The primary outcome was the change in Numeric Rating Scale (NRS) scores between pre-procedure and one week, one month, and 6 months post-procedure. The secondary outcomes were the change in morphine equivalent daily dose (MEDD) between pre-procedure and one week, one month, and 6 months post-procedure, and whether the primary cancer type (lung vs. non-lung) or radiotherapy to the chest within one month affected the outcomes of RFA. The Wilcoxon signed-rank test was used to compare RFA data between pre and post-procedure and P values less than 0.05 were considered statistically significant. Results: One hundred patients were included in the final analysis. The median NRS score in patients who underwent RFA decreased from 7 (range 3–10) pre-procedure to 4 (0–9) at one week and one-month post-procedure (both P < 0.001) and 4 (1–8) at 6 months post-procedure (P < 0.001). The median MEDD value decreased from 200 (range 30–1800) mg pre-procedure to 180 (10–1600) mg at one week post-procedure (P < 0.001), but there was no statistically significant change at one month (P = 0.699) or 6 months (P = 0.151) post-procedure. There was no difference in RFA outcome according to type of primary cancer or radiotherapy to the chest within one month. Limitations: Retrospective design. Conclusion: Radiofrequency thermocoagulation of the thoracic nerve roots achieved effective short-term pain control in patients with cancer and intractable chest wall pain. Key words: Radiofrequency ablation, thermocoagulation, thoracic nerve root, cancer, chest wall pain, radiotherapy, pain relief