Pain Therapy Using Acupuncture for Pleural Mesothelioma: A Clinical Case

Pain Therapy Using Acupuncture for Pleural Mesothelioma: A Clinical Case

Patient Data

- Demographics: Male, approximately 70 years old.

- Clinical Condition: Right-sided oncologic chest pain from mesothelioma, radiating to the right arm.

- Other Symptoms: No other psycho-physical symptoms.

Radiology

- Right pleural lesions, one of which is paravertebral at D8.

- Rib lesions.

- Right pleural effusion.

Pain Characteristics

- Type: Fixed, stabbing pain.

- Intensity:

  - Current: NRS 2.

  - Nighttime: NRS 10.

- Medications Taken: Depalgos (5 mg/325), not always effective.

- Additional Characteristics:

  - Nighttime peaks.

  - Radiating to the right arm.

  - Responsive to ice.

Current Therapy

- Targin 15 mg twice/24h.

- Dabigatran.

- Other non-significant medications.

Therapeutic Reflections

I want to avoid NSAIDs due to ongoing dabigatran. We will increase opioids and introduce pregabalin, but in the meantime, we will perform acupuncture.

First Acupuncture Session

Selected Points

- PC6, SJ6, LI10, LI15.

- Sensitive auricular point (anterior to the midpoint of the antihelix).

- LI3 left.

- GB41 right.

Rationale for Selection

- Ice response: I preferred to avoid local points, fearing they might trigger further inflammation in the affected area (I am aware that, for all we know, the opposite could also occur: these are still reflections not supported by literature).

- Goal: I hoped to evoke phenomena like “gate-control.”

- LI10: Included because it was painful upon palpation.

- Auricular point: Extremely sensitive to both palpation and needle insertion. Notably, the ear contralateral to the pain had no sensitivity.

- LI15: I don’t clearly recall the reasons for choosing it, whether influenced by literature or because it belongs to the distinct lung meridian, which proved useful in cases of respiratory insufficiency described in the text “Insegnamenti di agopuntura” (Menichelli) by Dr. Laura Barile.

- LI3: Chosen to target a completely distal and contralateral area to the pain. It is also described as useful for analgesia.

- GB41: Inserted to distally target the meridian involved in the pain (only this meridian had persistent pain in the final minutes of the procedure).

- PC6 and SJ6: Included for relaxation purposes and also hoping for a gate-control mechanism at the level of the first thoracic metamere (certainly too high relative to the pain site, but I didn’t have arm points innervated by lower metameres available 🙂).

Results

- At the end of the session: NRS 0.

- Duration of benefit: Only 2 hours.

Second Acupuncture Session

Initial Conditions

- Pain: NRS 7, same characteristics, despite doubling the opioids.

- Actions: I urge the introduction of pregabalin.

Selected Points

- Repeated acupuncture with the same points as the first session, except GB41.

Results

- After about 3 minutes: NRS 0.

- Duration of benefit: 3 subsequent days (pregabalin not yet introduced).

Final Reflections

- Auricular points: They have repeatedly shown in my experience an effective correlation with distinct anatomical sites. Sensitive points often lead to pain reduction when stimulated (though perhaps other ear points, not just the sensitive ones, could also work) in ways so immediate they seem “magical.” There is already a fair amount of literature attempting to explain their mechanisms.

- Conclusion: The clinical case demonstrates the actual possibility of treating pain using only points distant from the affected site.

Contacts

- Email: davidecorvi@gmail.com