Analgesic treatment of refractory cancer pain caused by bone and soft tissue metastasis of lower esophageal and cardial adenocarcinoma: A case report

Rationale: Pain management in patients with malignant tumors and concomitant bone and soft tissue metastases remains a significant clinical challenge, with 10% to 20% experiencing refractory cancer pain. These patients often present with multiple comorbidities and abnormal biochemical markers, necessitating a multimodal approach to therapy. The personalized application of patient-controlled analgesia (PCA) technology has shown promise in enabling swift and effective pain management.

Patient concerns: A 66 year old male patient with metastatic lower esophageal cardia cancer was hospitalized due to uncontrollable right chest and back pain. Effective control was achieved through multimodal comprehensive treatment, especially the application of PCA technology. At the same time, the patient also received the opportunity of antitumor therapy.

Diagnoses: He was diagnosed with (1) stage IV cardial adenocarcinoma of lower esophagus (rT3N0M1); (2) secondary malignant tumor of bone; (3) refractory cancer pain (numerical rating scale score 6 scores); (4) chronic viral hepatitis B; (5) hepatic insufficiency; (6) incomplete intestinal obstruction; and (7) chronic erosive gastritis.

Interventions: The complete process of cancer pain treatment for a patient with lower esophageal and cardia cancer was analyzed. The titration and rotation of opioid dosage, adjuvant treatment of underlying diseases, prevention and treatment of drug-related adverse reactions were introduced, with emphasis on PCA rapid titration.

Outcomes: The patient’s cancer pain is well controlled, with mild adverse reactions and timely treatment. In addition, the patient also received antitumor treatment (radiotherapy and targeted therapy).

Lessons: This case underscores the importance of comprehensive evaluation and precise diagnosis in cancer pain management, highlighting the need to address underlying conditions, conduct multidisciplinary consultations, and develop personalized analgesia plans. Such approaches can enhance pain treatment efficacy, minimize adverse reactions, and improve the overall quality of life for cancer patients.