Successful Multimodality Management of Refractory Cancer Pain on Shoulder Caused by Lung Cancer Metastasis and Resistant to Analgesics: A Case Report

Background: This case describes a successful management of patient suffered from refractory cancer pain and with poor response to any analgesic.

Case Presentation: A 61-year-old woman suffered from severe refractory shoulder pain cause by lung cancer metastasis with bone destruction, pancoast syndrome and local soft tissue invasion. Opioid and other medication is completely ineffective, accompanied with obvious side effect of severe drowsiness.

Case Management: Multiple department treatment (MDT) group were initiate to evaluate the main component of pain and etiological therapy: 1) bone metastases pain; 2) Neuropathic Pain cased by brachial plexus invasion; 3) compression pain associated with soft tissue swelling. Palliative bone radiotherapy, neurosurgical intervention and sodium aescin were successively used due to the patient’s changing symptoms.

Case Outcome: The patient was successfully relived from the pain remission sustained for 5 month. NRS score reduced from 8 to 2 with low dose of opioid and no side effect of drowsiness.

Conclusion: Successful and personalized management of refractory cancer pain depends on the evaluation of changing symptoms, etiology analysis and multidisciplinary teamwork. New approaches are recommended to pain management, especially the axillary nerve pulse radiofrequency surgery.

Keywords: Refractory cancer pain; Pancoast syndrome; Lung cancer; Metastasis; Neuropathic pain; Pain management