Analgesic Effect of a Single Dose of Adenosine for Neuropathic Pain Reduction in a Patient with Primitive Neuroechtodermal Tumor

Background: We report the analgesic efficacy of lumbar epidural adenosine injection in reducing the chronic neuropathic pain in a patient with primitive neuroectodermal tumor. Report of the Case: In this case report a 13-year-old male with primary neuroectodermal tumor (PNET) was administered in epidural space with adenosine to reduce his pain. The patient received 10ml of 0.25% ropivacaine and 2mg adenosine in the epidural space using the L4-L5 interspinous approach. The neuropathic characteristics were assessed using Douleur Neuropathic 4 (DN4) neuropathic pain diagnostic questionnaire. We also evaluated the pain intensity using the visual analogue scale (VAS). The sedation score, patient’s satisfaction, nausea and vomiting and the use of additional analgesia at 1, 3, 7, 15 and 21 days after the procedure were recorded. Result: The DN4 neuropathic questionnaire and VAS pain intensity scores before intervention were 8/10 and 9/10 respectively. After 3 and 7 days, they both decreased to 3/10. Level of sedation as well as nausea and vomiting were satisfactory. Conclusion: The bolus epidural administration of adenosine might improve the cancer related chronic neuropathic pain. Keywords: Adenosine, primitive neuroectodermal tumor, cancer, pain.