Assistant Professor of Orthopaedics & Rehabilitation Yale School of Medicine New Haven, Connecticut, United States
Case Diagnosis: Brachioradial pruritus (BRP) is characterized by localized neuropathic itching, typically of the dorsolateral upper extremities. This case report details the evaluation and management of a 58-year-old female with BRP.
Case Description: A 58-year-old female with a history of thalassemia trait presented with a 7-year history of cyclic pruritus predominantly affecting the left side. Despite multiple treatments, including gabapentin and various topical creams, her symptoms progressively worsened with inadequate relief and significant side effects. Cervical spine MRI revealed cervical disc herniation with nerve compression of C6 nerve root. The patient sought consultation for a stellate ganglion block, having heard about its potential efficacy from other BRP patients.
Discussions: Given the refractory nature of her symptoms, a multidisciplinary approach was adopted. Initial management involved tapering off gabapentin due to its side effects. A diagnostic cervical transforaminal epidural steroid injection (C7 TFESI) was scheduled to address axial/radicular symptoms, with the aim of enabling the patient to restart home exercises and therapy to prevent physical deconditioning. The patient was advised that a stellate ganglion block may be attempted if the C7 TFESI did not provide relief. However, the C7 TFESI procedure was canceled after the patient reported a cessation of symptoms following the gabapentin taper, given the episodic nature of BRP. The patient has not returned for further BRP-related concerns.
Conclusions: BRP management remains complex due to its multifactorial etiology. This case underscores that gabapentin, while effective in other reports, did not benefit this patient, and her pruritus paradoxically resolved following the medication taper. The management of BRP requires a comprehensive, multidisciplinary strategy to address the neuropathic aspects of the condition. This case highlights the importance of a tailored, patient-centric approach, integrating pharmacological, interventional, and physical therapies.
