Abstract

Aims: To present a case of refractory tenesmus in a patient with metastatic rectal cancer and to highlight a comprehensive, opioid-based, multidisciplinary approach to symptom management in a palliative care context.
Methods: A 29-year-old male with metastatic rectal adenocarcinoma experienced severe tenesmus unresponsive to standard opioids. A tailored pain management plan was developed, incorporating opioid rotation, adjunctive therapies, and input from a multidisciplinary team.

Results: Initial use of transdermal fentanyl and oral oxycodone failed to control symptoms. Transition to intravenous fentanyl infusion with rescue dosing, followed by the addition of methadone, resulted in partial relief but required careful monitoring due to respiratory depression. The incorporation of pregabalin, duloxetine, topical lidocaine, and nifedipine resulted in a marked improvement in symptoms and a decreased need for breakthrough analgesia.

Conclusion: Refractory tenesmus in advanced malignancy may require a flexible, multimodal treatment strategy. This case underscores the importance of individualized care plans, opioid rotation, and integration of non-opioid therapies for adequate symptom control.

 

Keywords

tenesmus, palliative care, opioid therapy, rectal adenocarcinoma, methadone, pain management