Aims:
Cancer pain is a major source of morbidity, affecting 24–60% of patients receiving active treatment and 69% with advanced disease. Central neuropathic pain, arising from spinal cord injury or disruption of central pain pathways, is particularly difficult to manage and often responds poorly to conventional analgesics. This case describes successful use of oral baclofen for refractory central neuropathic pain in a patient with metastatic cancer, alongside a brief review of relevant mechanisms and evidence.
Case:
A 62-year-old man with metastatic renal cell carcinoma involving the lungs and thoracic spine developed severe central neuropathic pain following metastatic epidural spinal cord compression at T7-T8. He underwent urgent T6-T9 decompressive laminectomy and posterior fusion, followed by postoperative radiotherapy. Despite partial motor recovery, he experienced persistent burning, electric shock-like pain with allodynia and dysesthesia below the lesion. Pain intensity was 9/10 despite multimodal therapy including high‑dose oxycodone, pregabalin, duloxetine, paracetamol, dexamethasone, and physiotherapy. The pain significantly impaired sleep, mobility, rehabilitation, and tolerance of further systemic therapy.
Oral baclofen was commenced at 5 mg three times daily and titrated to 20 mg three times daily over two weeks with monitoring for sedation, dizziness, muscle weakness, and renal function. Within three weeks, average pain scores improved to 3/10, breakthrough pain decreased, opioid rescue use declined, and sleep and functional participation improved. Baclofen was well tolerated, with only mild transient drowsiness during titration.
Conclusions:
Central neuropathic pain is associated with spinothalamic tract disruption and reduced inhibitory GABAergic signalling, resulting in neuronal hyperexcitability. Baclofen, a selective GABA‑B receptor agonist, enhances inhibitory neurotransmission and may attenuate abnormal pain signalling. This case suggests oral baclofen may be a useful adjunct for refractory central neuropathic pain in selected oncology patients when standard therapies fail. Further prospective studies are needed to clarify its role in oncology and palliative care practice.