Management of Refractory Cancer Pain in Advanced Mesothelioma; Success of Neuraxial Analgesia with Tunneled Epidural Port Catheter: A Case Report

Abstract

Introduction: Refractory cancer pain is one of the greatest challenges in palliative care, especially in aggressive cancers with a high symptom burden, such as malignant pleural mesothelioma. This rare and fatal disease presents mixed pain that often remains significant despite initial measures, making it necessary to combine different approaches to achieve satisfactory relief. Presentation of Case: We present the case of a 27-year-old woman with metastatic mesothelioma and abrupt functional decline, whose breakthrough and refractory pain caused her profound physical and emotional suffering. Despite systemic morphine administration, relief was insufficient. Given the urgency, continuous epidural neuraxial analgesia (ropivacaine and morphine) was initiated, achieving substantial pain control and greater well-being for the patient. The need for a safe discharge plan and the patient's limited life expectancy led to the placement of a tunneled epidural port. Conclusion: This device enabled effective pain and anxiety management at home, reaffirming the value of specialized intervention for patients in advanced stages of their illness. The comprehensive, person-centered approach, focused on their dignity, demonstrated how symptom optimization contributes to quality of life.