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Interventional Management of Chronic Neuropathic Cervical Pain Following Nerve Sheath Tumor Resection and Radiation:
Kevin Tran1, Evan Banks1, Mahmood Gharib2
1Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN.
Background:
Chronic neuropathic pain after head and neck cancer is common and difficult to treat, especially when compounded by surgical and radiation-related neural injury. This case illustrates persistent superficial cervical plexopathy after tumor resection and adjuvant radiation with limited response to standard therapy.
Case Report:
A man in his 30s developed constant, allodynic left anterolateral neck pain after resection of a carotid triangle nerve sheath sarcoma and postoperative radiation. Conservative measures (physical therapy, topical agents, gabapentin) provided minimal relief. An ultrasound-guided superficial cervical plexus block resulted in only transient pain relief, with symptoms recurring within hours. A trial of 2 cycles of botulinum toxin type A injections resulted in minimal and nonsustained improvement.
Conclusion:
Post-treatment cervical neuropathic pain can be refractory despite standard care. A multidisciplinary, individualized approach that integrates diagnostic blocks, targeted interventions, and cancer rehabilitation may improve function and quality of life in selected patients.