Splanchnic nerve neurolysis and methadone significantly decrease opioid consumption for severe back pain caused by abdominal para–aortic lymph node swelling: a case report

Abstract

Background: Noxious stimulation caused by abdominal para–aortic lymph node (PAN) swelling sometimes causes intractable back pain. It is speculated that splanchnic nerve neurolysis (SNN) blocks the transmission of this noxious stimulus at the splanchnic nerve level and exerts an analgesic effect. Case presentation: The patient was female in her 50s who underwent a radical surgery for rectal cancer, but lumbar spinal metastasis appeared two years later, and pain relief was achieved with opioids and radiotherapy. However, four more years later, her back pain gradually worsened, and then CT imaging revealed PAN metastases which were thought to be the cause of this backache. When SNN was performed and the opioid was switched to methadone, the required amount of opioid and drug cost were reduced by more than one tenth. Conclusion: SNN combined with switching opioid to methadone may be a treatment of choice for intractable back pain due to PAN swelling.

Progress summary.

umbers indicate the dose of each drug (mg/day). Cost of opioids include around–the clock opioids and rescue doses.