Safety-Adapted Laser and Auricular Acupuncture as Adjunctive Analgesia in an Elderly Patient With Cancer Pain and Hepatic Coagulopathy: A Case Report

Introduction Acupuncture has demonstrated efficacy as a non-pharmacological adjunct for cancer pain; its application in elderly patients with hepatic coagulopathy remains insufficiently described. Case Presentation A 67-year-old male with hepatocellular carcinoma, liver cirrhosis secondary to chronic hepatitis C, and spinal metastases was referred for acupuncture to manage lower back pain radiating to the left leg [visual analog scale (VAS) score of 5], refractory to morphine sustained-release (morphine sulfate tablets [MST] 2 × 10 mg). Imaging confirmed an L3 compression fracture and extradural space-occupying lesion at L4–5 consistent with metastatic disease. Given coagulopathy secondary to hepatic synthetic dysfunction, a safety-adapted protocol was employed: laser acupuncture (Nogier frequency A, 292 Hz; 4 J per point; 40 mW) at body acupoints LI4, LR3, and ST36, combined with manual auricular acupuncture at the modified battlefield acupuncture (BFA) point (left ear) and lumbar point (right ear), with 30 min needle retention per session. Sessions were administered daily for three days, followed by three sessions per week until analgesic and mobilization targets were reached. Results Pain intensity decreased from VAS score of 5 to 1 following the intervention, administered concurrently with ongoing opioid analgesia. Predefined mobilization targets were achieved. No adverse events were recorded. Conclusion This case report documents a safety-adapted protocol combining laser acupuncture at body acupoints with manual auricular acupuncture as an adjunctive approach in an elderly cancer patient with hepatic coagulopathy. The clinical course was favorable, although no causal inference can be drawn. The findings are intended as hypothesis-generating for future controlled investigation.