ESRA Academy. Sifontes K. Sep 8, 2016; 138231; 0048 Topic: PAIN THERAPY (ACUTE - CHRONIC)
Karina Sifontes
Karina Sifontes

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Background and Aims:

Loin pain hematuria syndrome (LPHS) is a rare pain syndrome. The prevalence is about 0,012%(1). This syndrome is characterized by severe flank pain, associated with hematuria. LPHS is a diagnosis of exclusion as there is not a consensus on validated diagnostic criteria (1). There are limited treatment options, ranging from simple analgesia to invasive therapy (2,3).


CASE REPORT: A 20-year male patient is referred to the chronic pain ward with no diagnosis. He has had a severe unilateral right flank pain since 3 months ago. About the anamnesis the pain was worsening with episodes of gross hematuria, and history of psychological abuse, suspecting LPHS. All potential causes for the patient’s symptoms were excluded. The treatment was transcutaneous electrical nerve stimulation, tramadol with a partial response. Additionally, he presented a quadrantus lumbar myofascial syndrome which had a good response with a quadrantus lumbar block, decreasing the AVS 10 to 1-2 immediately.


DISCUSSION: LPHS is a difficult clinical scenario to diagnose and treat. About the clinical features is a poorly defined disorder and most patients presents at least 6 months of history of costovertebral pain, hematuria and a somatoform disorder. Treatment options are diverse including analgesic medications, interventional treatments with an important comorbidity like renal denervation, kidney autotransplantation, and nephrectomy.


CONCLUSION: Chronic pain management in LPHS could be complicated. Conservative measures when treating LPHS should be used first evaluated for each patient individually. Interventions such as percutaneous regional nerve blocks and surgical procedures, are invasive and not always effective.

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