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Ewing's sarcoma is a small round blue cell tumor; most commonly found in children and young adults, producing a high burden of symptoms, the most prevalent being pain that is usually severe and has a chronic behavior. Different neurotransmission pathways, channels and receptors propose that analgesic therapy be individualized. We present a case of Ewing sarcoma with severe neuropathic pain refractory to opioids with the aim of presenting an alternative analgesic management in this type of patients. [ABSTRACT FROM AUTHOR]

A 32-year-old woman without drug allergies. Former smoker. No background of interest. As a result of right dorsal pain and tumoring, she was diagnosed with a poorly differentiated carcinoma of unknown origin. CT showed soft tissue infiltration, right posterior and ninth rib cage, tenth and eleventh costal arch. Prior to initiating palliative radiotherapy, the patient was treated by the Oncology Service with: MST (130 mg/12 h), Abstral® (200 µg, 5-6 rescue dosis daily), Pregabalin (75 mg/night), dexketoprofen (25 mg/8 h), duloxetine 60 mg/night, dexamethasone 4 mg/day, metamizol 2 g/12 h. In the initial examination at the Pain Unit, pain of neuropathic characteristics was highlighted, with metameric distribution from the right thoracic paravertebral region to the anterior costal grid. She presented hyperalgesia, dysesthesia and allodynia on contact with clothes. Pain becomes more intense and she doesn't respond to medication; she also presents a lot of side effects (nausea, drowsiness, constipation). A therapeutic / prognostic test was performed with echoguided infiltrations, in the 9th, 10th and 11th right intercostal spaces with local anesthetic, achieving a disappearance of the clinic for twelve hours. Given the good response, ultrasound neurogytic blocks with 7.5% phenol were performed in each space. Subsequent to the neurolytic infiltration, the patient was able to reduce the daily doses of oral opioids and the side effects derived from them. Three months later there is still slight somatic pain, which responds to NSAIDs. [ABSTRACT FROM AUTHOR]

Pelvic cancer pain has been associated from malignancy of abdominal, gynecological and urological organs. Multiple mechanisms are involved in pelvic pain making its management challenging and requiring of a multimodal approach since early stages. Drugs, radiation and interventional therapies have been suggested for its treatment, being neurolytic superior hypogastric plexus block (NSHPB) an interesting approach because of its specificity. Sympathetic blocks are claimed to be safe, reports in the literature of complications from NSHPB are rare and improvement in analgesia and decrease opioid consumption has been described, but data regarding NSHPB is sparse. Considering the quality of these studies was generally poor (GRADE recommendation 2C), more prospective, randomized, controlled trials are needed to ratify the real efficacy of this technique. We present a case of challenging pelvic cancer pain regardless high-dose opioid therapy in a patient with diagnosis of rectal cancer progression. In that context, posterior NSHPB guided by computerized tomography (CT) was carried out and it kept its efficacy until his demise, two months later. [ABSTRACT FROM AUTHOR]

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Patients with pain caused by pancreatic cancer that has grown locally or because of superior abdomen neoplasms may have their quality of life diminished by the pain's intensity. This could be because of the pain itself or the adverse effects of the opioids supplied to reduce it. This study intends to describe the anatomical structures and the CT-guided celiac plexus neurolysis technique (CPNT), using a posterior bilateral paravertebral retrocrural approach (Moore's Technique), showing a series of patients treated following this procedure. All of the patients analyzed had an advanced neoplastic disease that caused a chronic abdominal visceral pain despite treatments employing non-steroidal antiinflammatory analgesics associated to opioids. Thirty CPNT were performed in twenty-eight patients. Twenty-four of them suffered from pancreatic cancer while the other four suffered from gastric cancer. Seventeen of them where males with an average age of 72 years. Moore's technique was applied to all patients. Results were considered excellent in twenty-three of these patients; while in five of them results were considered regular. Minor complications showed up in only 23% of the cases. No new sensations of pain were observed, neither related to the procedure nor to neurological or hemorrhagic reasons. [ABSTRACT FROM AUTHOR]

Patients with pain caused by pancreatic cancer that has grown locally or because of superior abdomen neoplasms may have their quality of life diminished by the pain's intensity. This could be because of the pain itself or the adverse effects of the opioids supplied to reduce it. This study intends to describe the anatomical structures and the CT-guided celiac plexus neurolysis technique (CPNT), using a posterior bilateral paravertebral retrocrural approach (Moore's Technique), showing a series of patients treated following this procedure. All of the patients analyzed had an advanced neoplastic disease that caused a chronic abdominal visceral pain despite treatments employing non-steroidal antiinflammatory analgesics associated to opioids. Thirty CPNT were performed in twenty-eight patients. Twenty-four of them suffered from pancreatic cancer while the other four suffered from gastric cancer. Seventeen of them where males with an average age of 72 years. Moore's technique was applied to all patients. Results were considered excellent in twenty-three of these patients; while in five of them results were considered regular. Minor complications showed up in only 23% of the cases. No new sensations of pain were observed, neither related to the procedure nor to neurological or hemorrhagic reasons. [ABSTRACT FROM AUTHOR]