Expanding Sphenopalatine Ganglion Block Use in Oncology: Multifocal Pain Relief in Metastatic Breast Cancer-A Case...

Facial pain in patients with metastatic cancer is often multifactorial, involving neuropathic, nociceptive, and treatment-related mechanisms. Conventional therapies such as opioids, neuropathic agents, and corticosteroids are frequently inadequate or poorly tolerated. The sphenopalatine ganglion block (SPGB) is a minimally invasive procedure that may offer effective pain relief; however, data on the use of this technique for cancer-related facial and somatic pain is limited.

We describe a 73-year-old woman with widely metastatic breast cancer who presented with severe, continuous facial pain involving her jaw, lips, cheeks, and ears, along with deep lower back pain, burning tongue pain, and bilateral thigh pain. Previous pharmacological treatments provided insufficient relief. She underwent multiple intranasal SPGB procedures with 0.5% bupivacaine administered via cotton-tip applicators. Following each treatment, she experienced nearly complete resolution of facial and somatic pain. That relief lasted from 3 days up to one week, even during concurrent chemotherapy and radiation therapy. The patient tolerated the procedures well, without adverse effects, and reported substantial improvement in her quality of life.

This case highlights the intranasal bupivacaine SPGB as a simple, safe, and effective noninvasive option for refractory cancer-related facial and somatic pain. The observed relief beyond craniofacial areas suggests potential central modulation of pain pathways. Further research is warranted to validate the SPGB as a palliative treatment in advanced cancer pain syndromes.