840 - Treatment of chronic xyphodynia with a combined bilateral erector spinae (ESP) block and bilateral T7 dorsal root ganglion (DRG) pulsed radiofrequency neurotomy (PRFN): A Case Report

Case Diagnosis: The clinical assessment was consistent with chronic xiphodynia.

Case Description: 83 year old male with history of non-Hodgkin lymphoma treated with chemotherapy complained of a 10 year Xiphoid process pain. Started after chemotherapy and worsened in the past year. Pain was burning in nature, non-radiating, intermittent, 9/10, lasting about 1 hour, unrelated to food. Denied any numbness or tingling. Pain affected quality of life, he was unable to tolerate it. Unable to identify aggravating factors. Alleviated slightly with heating pad. Denied history of rashes, shingles, other infections. Work-up by GI physician was negative. Physical exam unremarkable. Contrast CT chest abdomen and pelvis showed bifid appearing Xiphoid process with no significant surrounding soft tissue inflammatory changes. Bone scan showed a small focus of mild activity in the lower sternum may be associated with one of the rib costochondral junctions. Otherwise no significant uptake identified in the xiphoid process. On previous CT, the patient is known to have a prominent xiphoid process.

Discussions: Two pain generators were suspected, musculoskeletal and chemotherapy induced neuropathic pain. Bilateral ESP block for what was thought to be the MSK component of the pain, and bilateral T7 dorsal root ganglion pulsed radiofrequency neurotomy were performed. On follow up at 2 weeks pain intensity reduced by 90% as reported by patient with significant improvement in quality of life. At 2 month follow up he continued to have sustained relief with pain intensity only “slightly increased”, but not to his baseline.

Conclusions: A combined approach of erector spinae block and T7 Dorsal root ganglion pulsed radiofrequency neurotomy has potential application as a minimally invasive interventional treatment option for chronic xiphodynia. Further high-quality research is required to investigate adjustments to the pulsed radiofrequency stimulation settings and duration of pain reduction.