Using a multimodal approach to manage difficult visceral cancer pain: A case study

Abstract

Difficult visceral cancer pain is defined as pain that does not improve with conventional non-pharmacological and pharmacological strategies, including opioids and adjuvants, and occurs in up to 15% of patients with cancer. In oncological practice, we must be prepared to establish strategies for dealing with such complex cases. Different analgesic strategies have been described in the literature, including managing refractory pain through palliative sedation; however, this might become a dilemma from a clinical and bioethical point of view in end-of-life situations. We present the case of a young male patient with moderately differentiated intestinal-type adenocarcinoma of the left colon, with intra-abdominal sepsis, and for whom despite the multimodal treatment for difficult visceral cancer pain, the pain was refractory leading to palliative sedation. Difficult visceral cancer pain is a pathology that affects the quality of life of patients and is a challenge for pain specialists, for both pharmacological and non-pharmacological management.

Keywords: Difficult visceral cancer pain; analgesics; care management; opioid; refractory cancer pain; refractory pain in cancer.

Figure 1.

Magnetic resonance imaging of the pelvis. T2-weighted sequence, mass dependent on the rectum and superior rectosigmoid junction (orange arrowhead) and dilatation of the inferior rectum (arrow white).

Figure 2.

Magnetic resonance imaging of the pelvis. T2-weighted sequence, identifying a mass with circumferential, lobulated involvement of sigmoid walls (yellow arrowhead) and suspicious lymph nodes and mesorectal lymph nodes (white arrow).

Figure 3.

Magnetic resonance imaging of the pelvis, T2-weighted sequence shows dilatation of the inferior rectus (white arrow).

Figure 4.

Difficult visceral cancer pain syndromes. Created by authors.