Combination of Body Points and Battlefield Acupuncture in Pain Management of Stage IV Cervical Cancer with Rectovaginal Fistula in the Elderly

Background: Cervical cancer is a malignant neoplasm arising from the uterine cervix and may be associated with severe pain and complex complications in advanced stages. Pain management in advanced cervical cancer remains challenging, particularly in patients with fistula formation and those undergoing surgical intervention. Objective: This case report describes the role of acupuncture as an adjunctive therapy for pain and perioperative symptom management in a patient with advanced cervical cancer complicated by a rectovaginal fistula. Case: A 66-year-old woman with stage IVA squamous cell carcinoma of the cervix complicated by a rectovaginal fistula was treated at Cipto Mangunkusumo General Hospital, a tertiary referral hospital in Jakarta, Indonesia. Intervention: The patient received 11 acupuncture sessions consisting of manual body acupuncture at LI4, PC6, ST36, ST37, SP6, SP9, SP10, GB34, LR3, and KI3; auricular Battlefield Acupuncture (BFA); bilateral stomach and sacral auricular points; and auricular press needles applied to Shenmen and bilateral thalamus points. During hospitalization, the patient underwent laparotomy for stoma creation and nephrostomy. Perioperative auricular acupuncture was administered using the National Acupuncture Detoxification Association (NADA) protocol. Results: Pain intensity progressively decreased during the course of acupuncture treatment, with VAS scores improving from 7 to 0 after the 11th session. The patient demonstrated favorable perioperative and postoperative outcomes, with stable pain control and no significant postoperative symptoms. Conclusions: This case suggests that acupuncture—including body acupuncture, BFA, and perioperative auricular acupuncture using the NADA protocol—may serve as a beneficial adjunctive therapy for pain and symptom management in patients with advanced cervical cancer undergoing surgical intervention. Further controlled studies are warranted to evaluate its efficacy in similar clinical settings.