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Lung Cancer with Plexopathy 161

Nonpharmacological Approaches cold spoon) give strong evidence of a neuropathic
Nonpharmacological treatment approaches include epi- pain syndrome.
• In cases of neuropathic pain, a combination of
dural opioid application and continuous infusion of lo-
cal anesthetics via a brachial plexus catheter. However, anticonvulsants, antidepressants, and opioids
is usually more eff ective compared to an opioid
catheter dislocation and infection might be regarded
as a major obstacle in applying this form of therapy, es- monotherapy.
• Consider the use of methadone in cases of “in-
pecially in rural areas where anesthesiologists are not
available. tractable” neuropathic pain syndromes.
Cordotomy is a neurodestructive procedure in
which the anterolateral spinothalamic tract is destroyed References
to produce contralateral analgesia. Th e pain has to be
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ited. Important neurological complications include pa- tions. Pain 2007;132:237–51.
resis, ataxia, phrenic nerve paralysis, and in long-term [2] Jaeckle KA. Neurological manifestations of neoplastic and radiation-
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• In the clinical evaluation certain pain descrip-
tors (e.g., burning or lancinating pain) reported Websites
by patients in combination with neurological National Cancer Institute: www.cancer.gov
signs (e.g., hypoesthesia, allodynia, or pathologi- World Health Organization: www.who.int
European Association for Palliative Care: www.eapcnet.org
cal cold/warm thresholds) by bedside testing with
Non-Small Cell Lung Cancer Treatment (PDQ®):
simple tools (e.g., a cotton-wool tip, needle, or www.meb.uni-bonn.de/cancer.gov/CDR0000062932.html