Introduction Intrathecal phenol neurolysis is a treatment of last resort for specific refractory cancer pains. However, there is a paucity of evidence in the academic literature and no documented evidence of repeat injections on the same patient. We aim to present our experience and learning from repeat interventions (3) on the same patient in order to further the evidence base for medical professionals managing chronic pain in a palliative care setting.

Case The patient, a 51 year old male, had inoperable rectal cancer and a defunctioning colostomy. Before treatment he was a hospice inpatient receiving a daily equivalent of 1280 mg oral morphine and subcutaneous midazolam, only comfortable lying flat in the lateral position.

Methods Informed consent included risk of permanent incontinence and lower limb nerve damage. Injections one and three were carried out sitting using Entonox. Injection two was carried out in the left lateral position due to pain. 6% phenol and 0.5% contrast formed the injectate. We positioned the patient in the sitting position post procedure to allow for appropriate Injectate spread. We recorded pre and post intervention analgesic requirements, subjective benefit, complications, and time to return of symptoms.

Results Injections 1 and 3 had instant prolonged analgesic effects; daily morphine doses fell by 870 mg and 240 mg respectively. Injection 1 lead to a temporary left foot drop and permanent urinary catheterisation. Injection 2 had little effect.

Conclusions Intrathecal phenol neurolysis can be highly effective in treating refractory cancer pain. Observed side effects were both temporary and permanent. Pain may return, but safely repetition of the intervention is possible. Patient position is important, our lateral injection was ineffective. This case study is the first described report of repeated interventions on the same patient. It adds to the body of documented evidence supporting its use in a palliative setting.