S271 S290
patella, and bilateral medial/lateral ankles. Range of motion,
strength, reflexes, and sensation were normal. X-rays of bilateral
knees/ankles and DEXA scan were unremarkable. Bone scan showed
diffuse mildly increased tracer uptake in bilateral distal femurs and
proximal tibias. MRI showed bilateral patellofemoral and medial
chondral disease.
Setting:
Outpatient.
Results:
Patient was suspected to have calcineurin inhibitor induced
pain syndrome (CIPS). Due to hepatic steatosis, she couldn’t be
switched to another immunosuppressant. Patient reported improved
pain and standing/walking tolerance with calcitonin-salmon nasal
spray and increased dose of gabapentin 800-mg daily. Patient also
started acupuncture and reported 90% improvement in pain after
initial session.
Discussion:
CIPS is a rare disabling syndrome that should be consid-
ered in immunosuppressed patients with LE pain. This case illustrates
a patient with previously reported characteristic clinical features of
CIPS in addition to uncharacteristic neuropathic symptoms and imaging
findings. There have been several proposed hypotheses for pain
development including calcineurin inhibitor induced vascular distur-
bance, bone remodeling, and nociceptive modulation. These may all
contribute to the development of pain and account for the variation in
clinical symptoms and imaging findings. Also, there have been no
previous reports of acupuncture treatment for CIPS which provided
significant pain relief for our patient. Additional research into pain
generating mechanisms of calcineurin inhibitors may identify further
treatment options.
Conclusions:
Early recognition and management of CIPS can improve
quality of life. Further research into CIPS may provide additional and
more specific diagnosis/management guidelines.
Level of Evidence:
Level V
Poster 436:
Chemotherapy-Induced Peripheral Neuropathy Pain
and Postmastectomy Pain Syndrome in a Breast
Cancer Patient Managed with Neurostimulation: A
Case Report
Thomas Chai, MD (UT MD Anderson Cancer Center, Houston, TX,
United States), Siddarth Thakur, MD, Girish S. Shroff, MD
Disclosures:
Thomas Chai: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 57-year-oldwomanwith oncologic history
of breast cancer, s/p neoadjuvant chemotherapy, left total mastectomy,
and postoperative radiation therapy presents with chronic peripheral
neuropathic pain affecting the hands and feet since chemotherapy, and
chronic left arm pain/lymphedema since surgery and radiation therapy.
Her pain medication regimen included opioids, non-opioids, and adju-
vants, without adequate analgesia. She also underwent stellate ganglion
blocks, with minimal improvement in her pain. For refractory pain, the
patient was deemed an appropriate candidate for, and agreed to, a
neurostimulator trial, utilizing two cervical octrode leads at the C4
vertebral body level to capture upper limb pain, and two octrode thoracic
leads at the T8 vertebral body level to capture lower limb pain.
Setting:
Tertiary care hospital.
Results:
The neurostimulator trial was considered a success, as the
patient reported at least 50% relief in areas of her painful upper and
lower limbs, and the patient subsequently proceeded to permanent
spinal cord stimulator implantation surgery.
Discussion:
Chemotherapy is directly toxic to peripheral nerves and can
result inpainful peripheral neuropathy that can affect the hands and feet,
often progressing to involve a stocking-glove sensory distribution. This
pain can lead to cessation of chemotherapy, in severe cases. The symp-
toms may persist after treatment, becoming a chronic pain issue for the
cancer patient. In addition, after mastectomy surgery, hemithoracic and
upper limb pain may occur, and if it persists, leads to a chronic
neuropathic pain condition called postmastectomy pain syndrome. This
syndrome may in part be due to injury to the intercostobrachial nerve
during surgery. Radiation therapy is a risk factor. The presence of lym-
phedema in the affected part may aggravate the condition.
Conclusions:
Neurostimulation may be worth considering for both
chemotherapy-induced peripheral neuropathy pain and post-
mastectomy pain syndrome resistant to pharmacologic management.
Level of Evidence:
Level V
Poster 437:
Pain Associated with Trigeminal Neuralgia Effectively
Treated with Kinesio Taping: A Case Report
Benjamin Tracy, MD (University of Rochester Medical Center,
Rochester, NY, United States), Edward Lam, MD, Sara Salim, MD
Disclosures:
Benjamin Tracy, MD: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
The patient presented with autoimmune
anti-TNF associated demyelination polyneuropathy and trigeminal
neuralgia. Her trigeminal neuralgia pain had previously been
controlled with oxcarbazepine but this was discontinued due to
significantly decreased IgG levels. Consequently, she experienced
significant burning pain and discomfort in her right jaw, cheek and
neck from her trigeminal neuralgia which escalated to the point of
interfering with her ability to participate in her scheduled 3 hours of
daily therapy. She had a complex pharmacologic pain regimen that
included: nortriptyline, acetaminophen, baclofen, cyclobenzaprine,
gabapentin, fentanyl patch, and hydromorphone PRN. Topical agents
were then tried with both lidocaine and diclofenac gel not being
effective. Neurology was consulted and recommended a gasserian
ganglion block be performed by interventional radiology, which the
patient declined. After discussion with multiple teams on the different
non-invasive treatments therapeutic kinesio taping was initiated.
After treatment, the patient reported a significant reduction in her
trigeminal neuralgia pain and was able to participate in therapy.
Setting:
Acute inpatient rehabilitation facility.
Results:
Utilizing the same technique as would be done for applying
kinesiology tape for TMJ, kinesio taping was done on the patient. The
following day the patient reported a 75% reduction in her trigeminal
neuralgia pain. She was also able to reduce her Hydromorphone usage
from approximately 6 times a day to only 1-2 times a day, and had
improved participation in therapy.
Discussion:
This is the first reported case, to our knowledge, of a
patient being treated with kinesiology tape for pain associated with
trigeminal neuralgia.
Conclusions:
Kinesio taping may be an effective treatment for tri-
geminal neuralgia pain and further research is warranted.
Level of Evidence:
Level V
Poster 438:
Management of Low Back Pain in Pediatric Male with
Multilevel Vertebral Body Compression Fractures: A
Case Report
Michael J. Bonnette, MD (WA Univ/BJH/SLCH Consortium),
Jacob AuBuchon, MD
Disclosures:
Michael Bonnette: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
The patient is a 14-year-old male with a
distant history of T-cell Leukemia status post radiation, chemotherapy,
and bone marrow transplant, complicated by graft versus host disease
requiring long-term steroid usage who presented to the Pain Manage-
ment Clinic with acute worsening of long standing back pain. He also
had previously known multiple vertebral fractures and required bracing
and conservative management at the age of 7 for pain management. His
S271
Abstracts / PM R 9 (2017) S131-S290