Abstract
We report a home-care patient who received multiple radiofrequency thermocoagulation(RFT) to relieve cancer pain without increasing opioid dosage. A 46-year-old man had an uncontrollable lumbar backache and a lower-extremity weakness caused by bone metastases from pancreatic cancer. We provided epidural and intercostal nerve blocks and increased opioid dosage. As the cancer became advanced with accompanying spinal cord damage and respiratory failure he needed hospitalization. But he was discharged with domiciliary oxygen therapy because he desired to die at home. Rest pain was well controlled by opioid patch, but movement-exacerbated pain was not. Increasing the dosage was limited by a side-effect of somnolence. After RFT was applied at home to the Th6 and Th7 intercostal nerves and to the Th7 nerve roots at the hospital, opioid dosage decreased by half and somnolence disappeared. He received treatment with RFT on the Th3 and Th4 intracostal nerves, and he could work at home until just before death, as he had wished. The nerve blocks are useful even during home visit treatment.
