Introduction:

Cancer-related bone pain is common, debilitating, and frequently refractory to systemic therapies. Patients with

metastatic disease often experience prolonged hospitalizations due to uncontrolled pain, opioid-related adverse effects,

and limited therapeutic alternatives. 1Although opioids have traditionally been the cornerstone of treatment for severe

cancer-related pain, their use is constrained by adverse effects, tolerance, and reduced quality of life. Peripheral nerve

stimulation (PNS) is an emerging therapy for refractory cancer pain but is typically performed in the outpatient setting.

We describe the inpatient use of a continuous brachial plexus catheter as a bridge to PNS in a patient with severe

metastatic humeral pain, highlighting the value of collaboration between acute and chronic pain services.

Materials and Methods:

This report describes a single-patient case. Per institutional policy, the case was deemed exempt from IRB review as it

contains no patient-identifiable information. Written informed consent for procedures and publication was obtained

from the patient.

 Case Report:

A 92-year-old man with lung adenocarcinoma, chronic kidney disease, and chronic anticoagulation presented with

severe right upper extremity pain secondary to lytic metastatic disease of the humerus and a pathologic fracture.

Despite surgical fixation, he remained hospitalized for several months due to refractory pain. Multimodal

pharmacologic management was limited by comorbidities and adverse effects, including somnolence from gabapentin

and ketamine and contraindications to nonsteroidal anti-inflammatory drugs. He was maintained on methadone,

oxycodone, and oral dexamethasone with inadequate relief.

The acute pain service was consulted and placed an ultrasound-guided interscalene continuous catheter targeting the

C5–C7 nerve roots, infusing 0.2% ropivacaine at 4 mL/hour. This resulted in marked pain reduction and improved

alertness, enabling medication de-escalation. However, prolonged catheter dependence raised concerns regarding

discharge feasibility and long-term management.

After multidisciplinary coordination, he was transitioned from a continuous nerve block to temporary PNS. Following

10 days of infusion, the catheter was removed with full neurologic recovery, and a dual-lead brachial plexus PNS was

placed. After three days of subthreshold stimulation, he achieved complete pain relief, was weaned off opioids, and was

discharged to hospice with the PNS in situ.

Discussion:

Interventional pain techniques are effective for cancer-related pain, yet non-neuraxial catheter-based approaches remain

underutilized and understudied.2 Existing literature, largely limited to case reports and small series, suggests that

ultrasound-guided peripheral nerve blocks and continuous catheters provide substantial, opioid-sparing analgesia with a

favorable safety profile and longer duration than single-shot blocks. 3,4 Barriers to broader adoption include concerns

regarding catheter migration, infection risk, MRI compatibility, and follow-up infrastructure.5 This case demonstrates

that continuous peripheral nerve catheters can serve as an effective inpatient bridge to peripheral nerve stimulation,

challenging the traditional outpatient-only paradigm for chronic pain interventions. Importantly, close collaboration

between acute and chronic pain services enabled seamless transition across care phases, addressing both immediate

analgesic needs and long-term goals. This model highlights the potential role of transitional pain services in complex

oncology patients, where prolonged hospitalization, frailty, and refractory pain necessitate flexible, multidisciplinary

approaches. Broader adoption of such strategies may expand access to neuromodulation and improve quality of life in

patients with advanced cancer.