Interventional pain treatments for cancer pain

Paul J. Christo, Danesh Mazloomdoost

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Cancer pain is prevalent and often multifactorial. For a segment of the cancer pain population, pain control remains inadequate despite full compliance with the WHO analgesic guidelines including use of co-analgesics. The failure to obtain acceptable pain or symptom relief prompted the inclusion of a fourth step to the WHO analgesic ladder, which includes advanced interventional approaches. Interventional pain-relieving therapies can be indispensable allies in the quest for pain reduction among cancer patients suffering from refractory pain. There are a variety of techniques used by interventional pain physicians, which may be grossly divided into modalities affecting the spinal canal (e.g., intrathecal or epidural space), called neuraxial techniques and those that target individual nerves or nerve bundles, termed neurolytic techniques. An array of intrathecal medications are infused into the cerebrospinal fluid in an attempt to relieve refractory cancer pain, reduce disabling adverse effects of systemic analgesics, and promote a higher quality of life. These intrathecal medications include opioids, local anesthetics, clonidine, and ziconotide. Intrathecal and epidural infusions can serve as useful methods of delivering analgesics quickly and safely. Spinal delivery of drugs for the treatment of chronic pain by means of an implantable drug delivery system (IDDS) began in the 1980s. Both intrathecal and epidural neurolysis can be effective in managing intractable cancer-related pain. There are several sites for neurolytic blockade of the sympathetic nervous system for the treatment of cancer pain. The more common sites include the celiac plexus, superior hypogastric plexus, and ganglion impar. Today, interventional pain-relieving approaches should be considered a critical component of a multifaceted therapeutic program of cancer pain relief.

Original languageEnglish (US)
Title of host publicationRecent Advances in Clinical Oncology
PublisherBlackwell Publishing Inc.
Pages299-328
Number of pages30
ISBN (Print)9781573317009
DOIs
StatePublished - Sep 2008

Publication series

NameAnnals of the New York Academy of Sciences
Volume1138
ISSN (Print)0077-8923
ISSN (Electronic)1749-6632

Keywords

  • Analgesia
  • Cancer
  • Epidural
  • External epidural catheter
  • External intrathecal catheter
  • Implantable drug delivery systems
  • Infusion therapies
  • Intrathecal
  • Intrathecal pumps
  • Nerve blocks
  • Neuraxial therapies
  • Opioids
  • Pain
  • Pain pumps
  • Programmable pumps

ASJC Scopus subject areas

  • Neuroscience(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • History and Philosophy of Science

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  • Cite this

    Christo, P. J., & Mazloomdoost, D. (2008). Interventional pain treatments for cancer pain. In Recent Advances in Clinical Oncology (pp. 299-328). (Annals of the New York Academy of Sciences; Vol. 1138). Blackwell Publishing Inc.. https://doi.org/10.1196/annals.1414.034