Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Delayed Atrophy & Fibrosis from Cancer Radiation Therapy

Forum: Neurology Forum
Topic: Pain

Re: Delayed Atrophy & Fibrosis from Cancer Radiation Therapy

Re: Delayed Atrophy & Fibrosis from Cancer Radiation Therapy

Posted by CCF NEURO MD on May 22, 1997 at 15:48:35:

In Reply to: Delayed Atrophy & Fibrosis from Cancer Radiation Therapy posted by Charles Rubenstein on May 13, 1997 at 02:01:07:

: In 1968 I had radiation therapy on left side of my neck and shoulder for cancer. This followed four operations in the prior 15 months. I had no more problems until about 12 years later. Since then I have had increasing difficulty swallowing and with my voice (one paralyzed vocal cord and polyps removed twice on the other. I have been having increasing pain in my left arm, hand, shoulder and neck. The area on my shoulder is extremely sensitive. If it is touched I get an "electric shock" down my arm and hand. Since 1987 when I used to play golf until the present my arm, hand and fingers have gradually become paralyzed. I am taking this in stride. I am active doing volunteer work, gardening, exercising, etc. I keep busy at my own pace. I am having myofacia physical therapy which is gradually reducing the sensitive area in my shoulder. I have taken an excellent course on "Managing Chronic Conditions". I also work with a pain management doctor at Stanford Medical Center. I am currently taking the following pain medicines: Tegretol (100mg 4xday), Neurontin (300mg 2xday), wellbutrin (100mg 2xday) and baclofen (10mg 2 at bedtime). Results are somewhat variable; I have very good days and some days not so good. I have found using an icepack on my neck helps when I have a flareup as does relaxation. I try to ignore my pain and see it as being outside my body in the distance. I have a question about the medicines. I used to take prozac and switched to wellbutrin last October because I thought the prozac was making me drowsy. Since wellbutrin is not a tricyclic antideppresant is it as effective as prozac or other tricyclic antidepressents you have mentioned in other postings? Any other thoughts on my medicines? Thanks a lot for your help.
Charles Rubenstein

=
A complication of radiation therapy to the neck or axilla is radiation induced brachial plexopathy. It typically occurs when the dose of radiation is large (greater than 6,000 rads in some studies) to a particular area. It is an ucommon complication of radiation therapy; approximately 1-2 % of patients treated develop it. The onset may occur anywherere from 3 months to years after treatment (majority after 12 months). Symptoms may consist of weakness,loss of muscle bulk,loss of reflexes, sensory loss,tingling, excessive sensitivity to touch,burning, swelling and pain. Pain is a major problem in a number of patients such as yourself (20-30%). The radiation produces a fibrotic reaction of the nerves and surrounding tissues. It may also directly damage the nerve axon and myelin below the fibrosis. The general course is progressive. It is important in some patients to exclude local recurrence of their tumor which could produce a similar picture. As you have found medical and surgical procedures are often ineffective in relieving pain. A number of medications have been used with varying success including, tricyclic antidepressants, antiarrhythmics (ie. mexilitine), anticonvulsants (tegretol, dilantin, neurontin), nonsteroidal anti-inflammatories (ie. ibuprophen), steroids, narcotics and baclofen all to varying success. The success of each it patient dependent. Patients with chronic pain are best managed by a pain management unit. They may also advise you in regards to the effects of treatments such as Transdermal electrical nerve stimulation , paravertebral nerve blocks and surgical treatments including dorsal rhizotomy, dorsal root entry zone lesions, cordotomy (the effects of these results are quite variable in the literature). I would recommend you stick with your current pain management doctor for an organized step wise approach. If there comes a time that they cannot offer you more, they may be able to recommend a specialist in radiation plexopathies.
Here are 2 references I found on the medline: Seidman SM. Rossitch EJ. Nashold BS Jr. Dorsal rooot entry zone lesions in the treatment of pain related to radiation-induced brachial plexopathy. Journal of Spinal Disorders. 6 (1):44-7, 1993 Feb. Kori SH. Diagnosis and management of brachial plexus lesion in cancer patients. Oncology 9(8): 756-60 (discussion 765), 1995 Aug. I hope this information will be helpful to you. If you are in the Cleveland area in the future we would be more than happy to see you in the neuromuscular department in conjunction with pain therapy. Just call 1-800-223-2273 ext 45559.

[Neurology Forum]      [Neurology Forum Archives]

[Health News and Commentary]