(275) - Ultrasound guided posterior tibial nerve block for the management of chronic peripheral neuropathic foot pain secondary to sarcoidosis

Abstract

Sarcoidosis is a systemic inflammatory disease of unknown etiology involving multiple organ systems. Sarcoidosis affecting the central and/or peripheral nervous system is called neurosarcoidosis. The case presented focuses on the use of a single interventional therapy for the management of sarcoidosis-induced bilateral lower extremity peripheral neuropathy. A 53 year-old Caucasian male with a 14 year history of steroid-dependent, refractory pulmonary sarcoidosis, and neurosarcoidosis with resulting lower extremity pain secondary to peripheral neuropathy was referred for pain management. Prior to presentation, the patient had been tried on various pharmacological therapies, including but not limited to high doses of opioids (methadone/oxycodone), steroids, pregabalin, and duloxetine. Patient's severe bilateral plantar foot pain continued to adversely affect his functionality to the point of placing him on disability. Three sets of bilateral ultrasound guided posterior tibial nerve blocks were performed three months apart. The patient experienced significant pain relief after each block. His daily methadone consumption decreased by over 50% and his functionality improved significantly allowing him to return to work full-time as he was able to tolerate prolonged periods of standing and walking. Ultrasound guided posterior tibial nerve blocks should be considered as a first-line treatment option for peripheral neuropathic pain secondary to sarcoidosis, as it can diminish dependence on opioids, while simultaneously increasing functionality and quality of life of patients.