When Opioids and Regional Anesthesia Are Not Enough: A Case Report About “Total Pain” and the Merits of Multi-Professional, Multi-Dimensional, Patient-Centered Care

Background: The concept of “Total Pain” encompasses the interplay of physical, emotional, social, and spiritual suffering in palliative care patients. This case demonstrates how identification and consideration of “Total Pain” components by multidimensional and multiprofessional care may even make previously installed traditional pain management with regional anesthesia unnecessary. Case Description: An 80-year-old male with advanced bone-metastasized prostate cancer presented with severe pain in various regions of the body, refractory to comprehensive pharmacological pain management, including intrathecal anesthesia. A comprehensive approach in specialist palliative care addressed the patient’s emotional, social, and spiritual needs. Intrathecal analgesia could be weaned off, and instead oral opioids and co-analgesics could be established. Conclusion: Pain in advanced illness, when unresponsive to pharmacologic and invasive pain management, may be driven by multi-dimensional aspects of “Total Pain.” The identification and consideration of “Total Pain” by multi-dimensional and multi-professional care can be the key to alleviate these patients’ suffering.