Palliative care with cervical intrathecal infusion and external pump for a late-stage cancer patient with refractory pain A case report

Rationale: Intrathecal therapy, with a low complication rate, has become an alternative to standard pain management for treatment of neuropathic cancer pain. Patient concerns: Here, we reported a late-stage cancer patient with intractable neuropathic pain in his right neck, shoulder, and upper limb. Diagnoses: The pain started 2 years ago when the patient was diagnosed as squamous cell carcinoma with metastasis to right supraclavicular lymph nodes. Interventions: Cervical intrathecal infusion of morphine and bupivacaine with patient control analgesia by external pump was performed. The intrathecal catheter was located at the level of C6 vertebra. The initial concentration of bupivacaine and morphine were both 1mg/mL with infusion rate of 0.3mL/h and bolus of 0.3 mL. Subsequently, the concentrations increased to 2 mg/mL (bupivacaine) and 1.33mg/mL (morphine), with infusion rate to 0.6mL/h and bolus to 0.5 ml. Outcomes: The pain intensity decreased from numerical rating scale 6 to 7 to 2 to 3 at rest, and from 10 to 5 to 6 of breakthrough pain. Lessons: In conclusion, cervical intrathecal infusion requires low concentration but high doses of bupivacaine and morphine, which is safe and effective in cancer patients with refractory pain and short life expectancy.