Chronic postsurgical pain after emergency cervical fusion with iliac crest graft - a multimodal approach to a multifactorial problem. Case report

ABSTRACT

BACKGROUND AND OBJECTIVES:

Chronic postsurgical pain is a major surgical complication with an impact on quality of life. Persistent pain following cervical fusion with iliac crest graft can be due to patient positioning, cervical surgical technique or nerve injury during iliac crest harvesting. Treatment options for chronic postsurgical pain overlap with those recommended for neuropathic pain. However, other pain mechanisms may be present in these patients.

CASE REPORT:

Male patient, 51-year-old, with persistent pain five years after emergency cervical arthrodesis with an iliac crest graft. The patient was referred to the chronic pain department (CPD) for management of meralgia paresthetica. However, other significant pain etiologies were found and treated such as nociceptive neck pain, myofascial lumbar pain, and inguinal neuropathic postsurgical pain. The therapeutic approach included multimodal pharmacotherapy with anticonvulsants, antidepressants, weak opioids, topical capsaicin 8% patch, as well as nerve blocks. After almost two years of follow-up, CPD discharge was possible, with minimal pain and return to baseline activity.

CONCLUSION:

Although the patient had a long course of undertreated postsurgical pain, a multimodal approach targeting different pain etiologies allowed the achievement of satisfactory pain control and return to baseline physical activity.

Keywords:
Chronic pain; Combined modality therapy; Drug therapy; Nerve block; Pain; Postoperative block