Intrathecal phenol neurolysis for refractory perineal cancer pain: A case report

Intrathecal chemical neurolysis with phenol is a neuroablative technique reserved for cases of refractory cancer pain in which pharmacological strategies and less invasive interventional procedures have failed. We report the case of an 87-year-old man with stage IV prostate cancer and severe perineal pain refractory to strong opioids and adjuvant analgesics, who underwent intrathecal phenol neurolysis as a last-resort intervention. Within 24 hours, the patient experienced a marked improvement in pain control, allowing progressive tapering and eventual discontinuation of systemic opioids. Adequate analgesia was maintained until the patient's death during the same admission, in the context of disease progression, without recurrence of severe pain. This case illustrates the potential role of intrathecal phenol in carefully selected palliative-care scenarios, where the primary therapeutic objective is relief of suffering and improvement of quality of life in terminal stages of illness.