Intrathecal neurolysis for the management of refractory pain in a patient with terminal oncological disease: case report

• Published in: Pain management Vol. 12; no. 5; pp. 569 - 577
• Main Authors: Rangel Jaimes, German William, Ortega Agón, Karina Alejandra, Cediel Carrillo, Ximena Julieth
• Format: Journal Article
• Language: English
• Published: England Future Medicine Ltd 01.07.2022
• Subjects: alcohol; anesthetics; blockade; Cancer Pain - drug therapy; Cancer Pain - etiology; ethanol; ethanol/administration and dosage; ethanol/therapeutic use; Female; Humans; injections; intractable/therapy; local anesthetics; local/therapeutic use; Neoplasms - complications; Nerve Block - methods; neurolysis; pain; pain management/methods; Pain, Intractable - drug therapy; Pain, Intractable - etiology; spinal; subarachnoid; terminal care/methods; treatment; alcohol; injections; treatment; pain; nerve block/methods; intractable/therapy; neurolysis; ethanol/administration and dosage; local/therapeutic use; subarachnoid; ethanol; local anesthetics; pain management/methods; spinal; anesthetics; blockade; terminal care/methods; ethanol/therapeutic use
• ISSN: 1758-1869; 1758-1877
• DOI: 10.2217/pmt-2021-0097

We report on the successful treatment of refractory cancer pain by intrathecal neurolysis using 96% absolute alcohol. A female patient with colorectal adenocarcinoma with metastases to the sacral bones, the patient had severe pain refractory to pharmacological and interventional treatment. Intrathecal neurolytic block at the L5-S1 intervertebral space was performed, she reported a significant improvement in her pain and decreased opioid use. The patient did not show deterioration of neurological functions after the procedure or associated complications, and outpatient treatment continued with a home medicine program. She remained comfortable until her death 6 weeks later. Considering that this is an accessible and cost-effective procedure, it could be a helpful alternative for the management of patients with refractory pain in the terminal stage. Pain is a widespread symptom in cancer patients, and approximately half of them do not improve with conventional management. Therefore, the WHO has proposed an analgesic ladder for pain management. In the fourth step of the ladder, analgesic interventions such as intrathecal neurolysis, which consists of the chemical destruction of the nerves, are administered to attain pain relief through the injection of substances into the subarachnoid space. In the following clinical case, we describe the use of this technique to relieve chronic intractable pain in a patient with advanced colorectal cancer, showing the benefits of this procedure in this group of patients.