Myofascial pain with psychosomatic features in an octogenarian female gastric cancer survivor treated with a psychosomatic approach: a case report.

Abstract

Background: Non-cancer-related pain in cancer survivors can be difficult to assess when symptoms are interpreted as cancer progression and when impaired bodily awareness limits engagement in self-care. Myofascial pain with psychosomatic features accompanied by marked alexisomia has rarely been described in gastric cancer survivors. This case report describes the clinical application of a structured, multi-stage psychosomatic approach for refractory myofascial pain with psychosomatic features in an octogenarian female gastric cancer survivor.

Case description: An octogenarian woman with recurrent gastric cancer, who had achieved complete response after pembrolizumab therapy, developed refractory episodic nocturnal pain in the bilateral upper back. The pain was unresponsive to nonsteroidal anti-inflammatory drugs and opioids. Computed tomography and clinical evaluation revealed no evidence of metastatic recurrence or structural lesions. Physical examination showed marked bilateral upper-back muscle tension and multiple trigger points, although the patient was initially unaware of this tension and attributed the pain to cancer progression. The Shitsu-Taikan-Sho Scale (STSS) score was 85, indicating marked alexisomic tendencies. A multidisciplinary home-based palliative care team implemented a four-stage psychosomatic approach: establishment of a therapeutic relationship, biopsychosocial assessment, development of insight into mind-body interactions using physical examination findings including the Armchair Sign, and introduction of self-care strategies such as progressive muscle relaxation. After the intervention, the worst Numerical Rating Scale pain score decreased from 7 to approximately 4, the STSS score improved from 85 to 62, and nighttime emergency nursing visits ceased.

Conclusions: This single case suggests that a structured psychosomatic approach combining physical examination, assessment of alexisomia, and facilitation of mind-body awareness may be feasible and clinically useful for supporting self-care in selected cancer survivors with refractory myofascial pain and psychosomatic features. Further studies are needed to clarify its generalizability and therapeutic contribution.