Diltiazem for the Management of Malignancy-Associated Perineal Pain and Tenesmus

Abstract

Based on our experience with these two cases, we propose oral diltiazem for use as an adjunct therapy for management of chronic malignancy-associated perineal pain, specifically with characteristics of pressure-type pain and tenesmus.

Management of orphan symptoms: ESMO Clinical Practice Guidelines for diagnosis and treatment†

“…93 Two patients had reduced pain, tenesmus and opioid requirements with diltiazem. 94 This approach was well tolerated but confounded by the use of other analgesics.…”

Treatment of Anal Cancer Pain—A Case Report

“…6 Calcium channel blockers have also been used to treat chronic malignancyeassociated perineal pressure like pain and tenesmus. 7 Symptoms associated with lumbosacral plexopathy, an unrecognized consequence of treatment of anal cancer treatment with chemotherapy and radiation, are usually treated with opioids, steroid suppositories, and lidocaine ointments. 8 Anal pain from low-lying rectal cancer, in patients who received preoperative chemoradiotherapy and underwent intersphincteric resection technique, was adequately controlled with opioids such as oxycodone.…”

A systematic review of the effectiveness of palliative interventions to treat rectal tenesmus in cancer

“…The results of the included studies are summarised in Table 1. Stowers et al 13 presented two patients with tenesmus treated with oral diltiazem. Both patients had reduction in pain intensity and reduction in total daily oral morphine equivalent (OME) use with no adverse effects.…”