Neurolysis: A Novel Approach To Treat Metastatic Pheochromocytoma

Pheochromocytomas are rare catecholamine-secreting tumors from the chromaffin cells of the adrenal system. The incidence of pheochromocytoma is approximately 2 to 8 per 1,000,000 individuals. Frankel F in 1886, first described Paragangliomas (PGLs) as extra-adrenal chromaffin cell tumors. Common extra-adrenal sites of tumor include bone, lungs, abdominal organs and lymph nodes. 15% to 35% of paragangliomas have been described to be malignant. Donelly et al, has attributed pain to be the most common symptom of cancer in over 80% of patients. Of which bone metastases is the most common cause of cancer-related pain. Robert E. Coleman found 30% of cancer patients postmortem to have evidence of metastatic bone disease. Intractable pain is often neuropathic in origin, arising from tumor invasion of nerve roots, plexuses or peripheral nerves. Bone metastases (BM) predispose patients to acute and chronic sequelaes such as immobilization, loss of independence, reduced quality of life and functionality. Cancer pain is particularly challenging to treat due to its progressive, multifocal, and complex disease process that is often debilitating. Interventional treatments can broadly be classified into either neuromodulatory or neuroablative. Neuromodulation is the alteration of pain pathways either by medication or stimulation. Neuroabalation is the interruption of the pain pathway by chemical or thermal modalities. We report on a patient with metastatic pheochromocytoma who presented with incapacitating hip pain who was treated with neurolysis.