Intrathecal Neurolysis for the Management of Refractory Pain in a Patient with Terminal Oncological Disease: Case Report

Abstract

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.

Plain language summary

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.

Keywords:

• alcohol
• blockade
• ethanol
• local anesthetics
• neurolysis
• pain
• subarachnoid
• treatment

MeSH keywords: :

• anesthetics
• ethanol/administration and dosage
• ethanol/therapeutic use
• injections
• intractable/therapy
• local/therapeutic use
• nerve block/methods
• pain
• pain management/methods
• spinal
• terminal care/methods

Author contributions

JGW Rangel patient was responsible for the management and analgesic intervention. AK Ortega performed writing, evaluation of evidence and medical management of the patient. CXJ Cediel was responsible for the bibliographic review, writing, scientific verification of the evidence and corrections.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved. The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.