BACKGROUND: Chronic neuropathic pain after head and neck cancer is common and difficult to treat, especially when compounded by surgical and radiation-related neural injury. This case illustrates persistent superficial cervical plexopathy after tumor resection and adjuvant radiation with limited response to standard therapy.

CASE REPORT: A man in his 30s developed constant, allodynic left anterolateral neck pain after resection of a carotid triangle nerve sheath sarcoma and postoperative radiation. Conservative measures (physical therapy, topical agents, gabapentin) provided minimal relief. An ultrasound-guided superficial cervical plexus block resulted in only transient pain relief, with symptoms recurring within hours. A trial of 2 cycles of botulinum toxin type A injections resulted in minimal and nonsustained improvement.

CONCLUSION: Post-treatment cervical neuropathic pain can be refractory despite standard care. A multidisciplinary, individualized approach that integrates diagnostic blocks, targeted interventions, and cancer rehabilitation may improve function and quality of life in selected patients.

KEYWORDS: Neuropathic pain; cervical plexopathy; nerve sheath tumor; head and neck cancer; radiation fibrosis; peripheral nerve block; case report