• Yanxin Ju, Demin Tian, Yanqin Tan, and Zhijian Fu.
• Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Shandong China.
• Medicine (Baltimore). 2018 Jan 1; 97 (4): e9714.

RationaleIntrathecal therapy, with a low complication rate, has become an alternative to standard pain management for treatment of neuropathic cancer pain.Patient ConcernsHere, we reported a late-stage cancer patient with intractable neuropathic pain in his right neck, shoulder, and upper limb.DiagnosesThe pain started 2 years ago when the patient was diagnosed as squamous cell carcinoma with metastasis to right supraclavicular lymph nodes.InterventionsCervical 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 1 mg/mL with infusion rate of 0.3 mL/h and bolus of 0.3 mL. Subsequently, the concentrations increased to 2 mg/mL (bupivacaine) and 1.33 mg/mL (morphine), with infusion rate to 0.6 mL/h and bolus to 0.5 ml.OutcomesThe 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.LessonsIn 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.

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