Prolonged Dorsal Root Ganglion (DRG) Trial Adequately Treats Neuropathic Pain Due to Malignant Invasion of the Lumbosacral Plexus: A Case Report

BACKGROUND: Pain control remains a challenge for patients suffering from acute malignancy-induced pain. Dorsal root ganglion (DRG) stimulation, normally indicated for chronic pain syndromes, may be an effective tool against neuropathic pain in the setting of tumor invasion. CASE REPORT: A 63-year-old woman with a past medical history significant for stage 1A endometrial adenocarcinoma status post robotic total hysterectomy and a recently diagnosed presacral mass (high-grade undifferentiated squamous carcinoma) presented for neurosurgical evaluation due to subacute onset of urinary retention, constipation, weight loss, and left lower-extremity pain associated with dysesthesia and impaired gait. Magnetic resonance imaging demonstrated direct invasion of the inferior sacrum and moderate spinal canal stenosis. After a multimodal regimen failed, the inpatient pain service was consulted for consideration of advanced modalities. Since the patient experienced relief from an epidural steroid injection (ESI), the team placed DRG trial leads proximal to the sacral mass at the left L5 and S1 DRGs. The patient had an immediate postoperative pain reduction of 75% to 90%. The primary team and family elected for a prolonged trial (> 7 days) as the patient’s neuropathic pain was significantly improved until the patient expired 22 days post placement. CONCLUSION: To the best of our knowledge, this is the first DRG trial used to treat refractory, acute cancer-related pain. KEY WORDS: Acute pain, cancer, case report, dorsal root ganglion stimulator, DRG trial, lumbosacral plexus, malignancy pain, neuromodulation, neuropathy, pain