[MrPotatohead]

Thermal ablation for bone pain

by MrPotatohead on Sat Dec 08, 2018 8:17 pm

Hello everyone,

I have a question related to treatment for bone pain.

As I have mentioned in numerous previous posts, bone pain cause by multiple myeloma induced bone damage is my primary and most troublesome symptom. I have had two kyphoplasty procedures that have helped somewhat, and beyond that I have been told that opioid meds were my best hope (after dismissing steroid injections and either analgesic or electrical implantable pain pumps). And I do use Fentanyl patches, which have had some limited beneficial effect.

However, I have recently learned that a fellow sufferer is planning on having thermal ablation procedures to address his bone pain, which is comparable in severity to mine.

I was wondering if anyone else knows anything about this treatment for pain stemming from multiple myeloma bone damage. Does it have much chance of success? What are the possible downsides?

Thanks very much, and happy holidays!

[Multibilly]

Re: Thermal ablation for bone pain

by Multibilly on Sun Dec 09, 2018 10:50 am

Hi Mr. PH,

Are you talking about radiofrequency thermal ablation? I hadn't heard of this procedure before. But some of the articles on the web such as this one describing its use for myeloma certainly sound promising:

Gharaei,H, et al., "Radiofrequency Thermal Ablation in Painful Myeloma of the Clavicle," Korean Journal of Pain, Jan 2014 (full text of article)

Abstract:

A 57-year-old male patient had myeloma. He had severe pain in the left clavicle that did not respond to radio­therapy; therefore, it was treated with radio­frequency thermal abla­tion (RFTA). Under fluoro­scopic guidance, two RF needles at a distance of 1.5 cm from each other were inserted into the mass and conventional radiofrequency (90℃ and 60 sec­onds) at two different depths (1 cm apart) was applied. Then, 2 ml of 0.5% ropi­vacaine along with triam­cinolone 40 mg was injected in each needle. The visual analogue pain score (VAS from 0 to 10) was decreased from 8 to 0. In the next 3 months of follow-up, the patient was very satisfied with the procedure and the mass gradually became smaller. There were no complications. This study shows that RFTA could be a useful method for pain manage­ment in painful osteolytic myeloma lesions in the clavicle.

[Merryl]

Re: Thermal ablation for bone pain

by Merryl on Tue Dec 11, 2018 2:44 am

I had radio frequency ablation of certain spinal and pelvic nerves when I had an unrelated neuropathic pain condition about 8 years ago. For me, it flared my nerve pain for about 2-3 months, and then provided benefit for a few months.

Merryl

[MrPotatohead]

Re: Thermal ablation for bone pain

by MrPotatohead on Tue Dec 11, 2018 7:59 pm

Thank you, Multibilly, for the link. I imagine it is radio­frequency thermal ablation, but it was described to me as just “thermal ablation”. I’ll try to get more detail from the patient. I was surprised at its recommendation because none of the clinicians I have consulted concerning remedies for multiple myeloma caused bone pain had ever mentioned it as a potential therapy. Perhaps it only applies in cases where the myeloma results in a mass.

My thanks to you as well, Merryl. The patient I referred to does suffer from neuropathy, so perhaps that is why it was recommended in his case.

[MrPotatohead]

Re: Thermal ablation for bone pain

by MrPotatohead on Fri Dec 14, 2018 3:01 pm

It is indeed radio­frequency thermal ablation, and the myeloma patient who told me about it is having it to destroy a nerve that his orthopedic specialist has identified as generating his back pain as a result of com­pression by bones that have collapsed due to his myeloma.

Apparently this treatment is used for back pain that is also caused by other problems in addition to multiple myeloma. In general, a chemical nerve block is first tried to test whether the sus­pected nerve or nerves is/are indeed causing the pain. If the nerve block works, the ablation treatment is then applied. This all has to be done very carefully, making sure not to damage motor nerves since the treatment permanently destroys nerve tissue.

Despite my having consulted with multiple clinicians about my back pain, this was never sug­gested for me.

I have had two kyphoplasty procedures, steroid injections, and multiple pain medications, none of which have done very much for my pain.

So I will explore this option further.

Thanks again, Multibilly and Merryl, for your posts.