Integrated Pharmacological and Physiotherapy Approach in Chronic Osteosarcoma Pain: A Case Report

Abstract

Introduction: Chronic bone cancer pain arises from both nociceptive and neuropathic mechanisms, often causing impaired mobility, reduced quality of life, and psychosocial distress. While opioids remain the cornerstone of severe cancer pain management, adjunctive physiotherapy and non-pharmacological strategies provide added benefit. Evidence from India on multidisciplinary approaches to bone tumour pain remains limited. Case Presentation: A 27-year-old male with recurrent osteosarcoma of the right femur presented with severe pain (VAS 6/10), sleep disturbance, and functional decline. NSAIDs offered limited relief. A multidisciplinary plan was initiated, combining pharmacological and physiotherapeutic measures. Pain was controlled using rapid intravenous morphine titration, then oral morphine (10 mg four-hourly) with paracetamol and gabapentin. Physiotherapy included guided isometric strengthening and low-level laser therapy (LLLT) to the affected site. Outcome: Over four months, pain scores decreased from 6 to 1. EQ-5D-5L scores improved from 43352 to 22222, and EQ-VAS decreased from 61 to 12, reflecting reduced health burden. No adverse effects were noted, and adherence was excellent, with improvements in mobility, sleep, and overall well-being. Discussion: This case demonstrates that integrated management combining opioids, adjuvant therapy, and physiotherapy provides effective relief of bone cancer pain. Morphine offered rapid analgesia, gabapentin targeted neuropathic elements, and physiotherapy improved strength, function, and comfort. Conclusion: A multidisciplinary strategy with pharmacological and physiotherapeutic interventions achieved durable pain control and enhanced quality of life in a young patient with osteosarcoma.