{
  "abstract": "Background and Aims Effective pain management in cancer patients with advanced disease is critical to improve quality of life. We present a case of an elderly gentleman with metastatic parotid carcinoma with bony and pulmonary metastases, experiencing severe intractable chest pain from a right lung mass. Conventional opioid therapy provided insufficient relief and caused sedation-related limitations. This case highlights the utility of interventional pain procedures in such complex scenarios.Methods The patient, who was unable to lie supine due to severe chest pain, was receiving high-dose transdermal and intravenous fentanyl with limited relief. Patient underwent ultrasound guided right T5-T8 intercostal nerve neurolysis using a combination of phenol and local anaesthetic under monitored anaesthesia care. The procedure was conducted with the patient in a semi-upright position to accommodate his respiratory status.Results Post-procedure, the patient reported marked reduction in right-sided chest pain, allowing him to rest in a supine position and reduce opioid requirements. No immediate complications were observed. Pain relief was sustained over the following weeks and remained effective for up to 5 months, at the time of this case report, significantly improving his functional status and participation in palliative care.Conclusions Intercostal nerve neurolysis may be an effective option for managing localized, opioid-refractory chest wall pain in patients with thoracic metastases. Careful patient selection and procedural planning are essential, particularly in those unable to tolerate standard positioning due to respiratory or pain limitations.",
  "authors": [
    {
      "affiliations": [
        "Pain Management Center, Anaesthesiology, Singapore General Hospital, Singapore, Singapore"
      ],
      "name": "Kar Mun Tham"
    }
  ],
  "title": "EP059 Intercostal nerve neurolysis for opioid-refractory chest wall pain in metastatic parotid carcinoma: a case report",
  "uid": "d5a72298-4ecf-5a70-8a98-75eb5708cab6"
}