A Case of Relieving Cancer Pain in a Child with End-Stage Neuroblastoma

The patient, a boy named Li, aged 7, 110 cm tall and 15 kg, from Taizhou, Jiangsu, first sought my help on December 31, 2021.

The child was first diagnosed with neuroblastoma on July 30, 2018. On August 2, 2018, preoperative examination showed a huge mass in the right upper abdomen, about 93mm x 90mm x 124mm, with the liver displaced upward and leftward; surgery was decided upon. Postoperatively, strip-like soft-tissue shadows were seen above the right kidney, with multiple retroperitoneal lymph-node shadows. Postoperative radiotherapy and chemotherapy followed the standard protocol.

On July 11, 2019, a pancreatic-head metastasis was found. On April 22, 2020, examination at the Children Hospital Affiliated to Nanjing Medical University (CT no. 110200100883, outpatient no. 0001515319) showed a soft-tissue shadow behind the pancreatic head, about 29mm x 23mm x 38mm, larger than before, plus small nodules in both lungs.

He then continued chemotherapy at the provincial children hospital until the end of 2021, with poor effect; the disease progressed and his condition was serious, so the hospital recommended giving up. After returning home, he suffered unbearable pelvic pain from the metastatic lesions, with sore lower back, a limp, lumps rising on the scalp, swollen bruised eyes, subcutaneous petechiae, and refractory cancer fever, with temperature between 37.8 and 40 C. COVID nucleic-acid testing was negative and antibiotics were ineffective. He had been bedridden for over a month, and his family hoped I could ease his suffering.

Seeing how emaciated the child was, I also urged the family to give up, but they refused, weeping that they could not bear to see him in pain and begging me to try anything on a dying horse to give them some advice to ease his suffering. I suggested he try Chai Ge Jieji Tang: Chaihu (Bupleurum) 12g, Gegen (Pueraria) 9g, Gancao (Licorice) 3g, Huangqin (Scutellaria) 9g, Qianghuo (Notopterygium) 6g, Baizhi (Angelica Dahurica) 6g, Baishao (White Peony) 6g, Jiegeng (Platycodon) 6g, Sheng Shigao (Raw Gypsum) 12g.

The child took the above formula with no effect. I suggested the family buy Qiyelian tablets online and decoct them, 30-50g per dose. After taking it, his pain clearly lessened, but there was a diarrhea side effect. I told them to take it together with berberine tablets while reducing the Qiyelian dose; the diarrhea improved, but reducing the dose again made the pain relief inadequate.

On January 18, the child leg and lower-back pain returned, Qiyelian no longer worked, and the cancer fever had not resolved. The family asked me to think again. Since the child also had aversion to wind and cold, I suggested adding Qiyelian to Guizhi Jia Gegen Tang: Guizhi (Cinnamon Twig) 10g, Baishao (White Peony) 10g, Gegen (Pueraria) 20g, Zhi Gancao (Honey-fried Licorice) 6g, Qiyelian 15g, fresh ginger 5 slices, jujube 5 pieces.

This did not help much. On January 20, the child grandmother again asked me to adjust the prescription. Given that the root disease was neuroblastoma and the child was now very weak, I reluctantly tried again. Suggested formula: Sheng Huangqi (Raw Astragalus) 30g, Danggui (Angelica) 6g, Dangshen (Codonopsis) 15g, Huangjing (Polygonatum) 15g, Baizhu (Atractylodes) 6g, Fuling (Poria) 6g, Zhi Gancao (Honey-fried Licorice) 6g, Shudi (Rehmannia) 6g, Chuanxiong (Ligusticum) 6g, Baishao (White Peony) 6g, Qianghuo (Notopterygium) 6g, Duhuo (Angelica Pubescens) 6g, Sanleng (Sparganium) 6g, Ezhu (Curcuma) 6g, Yuanhu (Corydalis) 6g, Chaihu (Bupleurum) 6g, Huangqin (Scutellaria) 6g, Fabanxia (Processed Pinellia) 3g, Zhizi (Gardenia) 6g, Dan Douchi (Fermented Soybean) 6g, Lufengfang (Honeycomb) 15g, Xuchangqing (Cynanchum) 30g, Qiyelian tablets 15-30g.

One day later, the grandmother reported a temperature of 38.8 C with pain unchanged. I told them to add 30g Sheng Shigao (Raw Gypsum) and continue, along with some anticancer Chinese patent medicines. The cancer fever and pain did not improve. I believed the prescription logic was not wrong and should be taken for several days without rushing, so I added Daqingye (Isatis Leaf) 15g and Banlangen (Isatis Root) 15g and told them to take it for several more days.

By the 25th, the cancer fever had subsided and he no longer ran a fever; the cancer pain was markedly relieved and basically gone. During this period, because prolonged cancer fever had dried his stools, I had also added Dahuang (Rhubarb) 6g and Mangxiao (Mirabilite) 15g to the prescription, then removed them once his bowels moved.

After this adjustment, the child finally escaped, for now, the cancer fever and pain, and the lumps on his scalp subsided. But this child is seriously ill; after four years of surgery, radiotherapy, and chemotherapy, he is weak and his condition is already critical. Whether better results lie ahead can only be left to fate. If better results follow, I will update this case. This case is offered only as a reference for relieving cancer pain in similar patients.