Sacral epidural block ameliorates refractory plantar pain due to HIV-related neuropathy: a case report

Abstract

Case presentation: A 55-year-old male was diagnosed with HIV infection and had pain in both plantar. As his symptoms gradually progressed and eventually led to gait disorder due to the pain, he was referred to our pain management clinic. He complained of persistent stabbing pain in his plantar (maximal pain score was 10 on the numerical rating scale: NRS; 0–10), which severely interrupted the patient's quality of life (QOL). He was diagnosed with HIV-associated peripheral neuropathy (HIV-PN), and his pain symptom was refractory to conservative medication therapy. As a trial sacral epidural block (0.5％ mepivacaine 10 ml) reduced his pain to NRS 7 for several weeks, we performed it repetitively once a month. Five years later from the first visit, his pain was in NRS 0–2 and his QOL was significantly improved. Conclusion: Although symptomatic control of HIV-PN is often challenging, repetitive sacral epidural block may be an effective treatment.