Abstract

To present a novel perspective of myofascial pathology as a cause of pain in cancer patient and to describe newer muscular interventional approach, ultrasound guided dry needling (USGDN) along with neural interventions.USGDN is a novel approach to dry needling, which is used as a treatment of myofascial pain syndromes (MPS), wherein a needle is inserted into a painful site in the muscle called myofascial trigger point (MTrP), under ultrasound vision. Case Description:65 years male, with pain NRS 9/10 over right scalp, face, neck, with restricted mouth opening, neck movements due to fibrosed muscles, stony hard sternocleidomastoid, masseter, lateral pterygoid with dyspnea in supine.He was already taking adequate dose of paracetamol, then started with oral pregabalin, tramadol and chlorzoxazone. In view of difficult anatomy and fixed flexion deformity of neck first started USGDN of scalp, neck, facial muscles with 32G solid needles. Post 2 sessions, neck muscles partially relaxed, flexion deformity improved with accessible stellate anatomy, stellate ganglion block was given and USGDN was continued.After 7 days pain reduced to NRS 5/10. Post 6 sessions, pin reduced to NRS 1-2/10 withimprovement in neck tightness,possible extension, absence of dyspnea in supine. Conclusion: Considering pain due to neuromyopathy, combined USGDN with neuromodulation proved to be effective in cancer pain and associated disabilities. Clinical Significance: Oral cancer pain is very challenging to treat and is also associated with multiple disabilities. Muscle relaxation with USGDN allowed to do neural interventions in this patient suggests that the intense muscle spasm led to the generation of MTrPs in the face, head, neck and masticatory muscles causing pain with restricted movements.Placement of fine 32-gauge solid needles in involved muscle produces local twitch reflex (LTR) followed by intense muscle relaxation leading to pain relief.

Description