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Post-dural puncture thoracic pain without headache: relief with epidural blood patch
1Department of Anesthesia and Pain Clinic, Brigham and Women's Hospital, Boston, USA.
Summary
Two patients experienced upper back pain after dural puncture, without headache. Epidural blood patching relieved this unusual post-dural puncture syndrome pain, suggesting nerve root traction as a cause.
Area of Science:
- Neurology
- Anesthesiology
- Pain Medicine
Background:
- Post-dural puncture headache (PDPH) is a known complication of dural puncture.
- The exact etiology of PDPH remains debated, with theories including intracranial hypotension and vascular changes.
Observation:
- Two cases of patients presenting with severe, postural upper thoracic interscapular backache following dural puncture are described.
- These patients did not experience the typical headache associated with post-dural puncture syndrome.
Findings:
- Both patients' symptoms were successfully resolved with epidural blood patching.
- The findings suggest that traction on cervical or upper thoracic nerve roots may be a contributing mechanism for pain in post-dural puncture syndrome, even in the absence of headache.
Implications:
- This study expands the understanding of potential pain mechanisms in post-dural puncture syndrome.
- It highlights the importance of considering nerve root irritation as a differential diagnosis for back pain after dural puncture.
- Epidural blood patching may be an effective treatment for this specific presentation of post-dural puncture syndrome.