A Cancer Pain Tutorial

A Comprehensive Visual Short Course
on Cancer Pain Management
Radiation Fibrosis of Brachial Plexus
radiation fibrosis of brachial plexus
Pain Type : Neuropathic
Cause: Thickening and Scarring of Nerve Tissue in Brachial Plexus Due to Radiation, May Occur Years After Exposure
Effects: Progressive Neurological Loss

Clinical Signs:
 Muscular Weakness, Senosry Changes
Diagnosis : EMG Studies, CT, MRI Scans

Radiation fibrosis of brachial plexus muscular weakness and sensory changes usually precede pain in radiation fibrosis of brachial plexus. The neurological loss is progressive and may occur years after radiation exposure.

Be sure to rule out recurrent tumor using EMG studies, CT, and/or MR scans.
Radiation Fibrosis of Lumbosacral Plexus
radiation fibrosis of lumbosacral plexus
Pain Type : Neuropathic
Cause: Thickening and Scarring of Nerve Tissue in Lumbosacral Plexus Due to Radiation, May Occur Years After Exposure
Effects:
Pain In Leg or Perineum

Clinical Signs:
 Muscular Weakness, Sensory Changes
Diagnosis : X-rays, CT, MRI

The pain in the leg or perineum is the presenting complaint.

One must distinguish recurrent tumor from radiation fibrosis. Conventional x-ray, as well as CT and MR scanning are helpful in the diagnosis.
Radiation Myelopathy
radiation myelopathy
Pain Type: Neuropathic
Cause: Radiation Therapy
Effects/Clinical Signs:

Constant Dull, Aching, Pressure-Like Sensation In Hip or Sacral Areas. Occasional Sensation of Burning.

 Pain Not an Early Symptom, Localized to Area of Spinal Cord Damage, Brown-Sequard Syndrome
Diagnosis : May Progress to Complete Transverse Myelopathy

Pain is not an early symptom of radiation myelopathy. Pain may be localized to the area of spinal cord damage.

The neurologic signs are those of a Brown-Sequard syndrome (ipsilateral motor paresis with contralateral sensory loss). The problem can progress to a complete transverse myelopathy.
Radiation Induced Peripheral Nerve Tumor
peripheral nerve tumor
Pain Type : Neuropathic
Cause: Radiation Therapy

Clinical Signs: Painful, Enlarging Mass

These tumors are unusual and can appear up to 20 years after radiation therapy.

A common clinical finding is a painful enlarging mass in the area previously irradiated.