Longnecker's Anesthesiology > Part 8. Care of the Chronic Pain Patient >

Chapter 94. Palliative and Cancer Pain Care

Phillip C. Phan, MD, and Allen W. Burton, MD

Treatment Modalities

Topics Discussed:

analgesics, non-narcotic; brachial plexus block; brachial plexus block by interscalene approach; brachial plexus block, infraclavicular; breast cancer; cancer pain; celiac plexus block; celiac plexus block technique; cryoanalgesia; cryoneurolysis; ethanol; ganglion impar; glycerol; greater occipital nerve block; hypogastric plexus block; infusion pumps, implantable; local anesthetic intercostal nerve block; lumbar sympathetic block; lumbar sympathetic block technique; lung cancer; malignant neoplasm of pelvis; management of cancer pain; nerve block; neurolysis; opioid analgesics; palliative and cancer pain care; pancreatic cancer; percutaneous neuromodulation therapy; perineal pain; pharmaceutical adjuvants; phenol; radiofrequency ablation; sarcoma; spinal catheter; stellate ganglion block; stellate ganglion block technique; superficial cervical plexus block; sympathetic nerve; sympathetic nerve block; treatment failure; trigeminal nerve block; vertebroplasty.

Sections:

Pharmacologic Therapy, WHO Guidelines, Nonopioid Analgesics, Adjuvant Medications, Opioid Analgesics, Failure of Noninterventional Therapies, Interventional Therapies, Goal of Intervention, Communication, Detailed Physical Examination, Categories of Interventional Techniques, Neurolytic Procedures, Neural Blockade in Head and Neck, Trigeminal Nerve Block, Occipital Nerve Block, Superficial Cervical Plexus Block, Neural Blockade in Upper Extremity, Brachial Plexus Block, Neural Blockade in Thorax, Intercostal Nerve Block, Sympathetic Blockade for Cancer Pain, Stellate Ganglion Block, Celiac Plexus Blockade, Lumbar Sympathetic Block, Superior Hypogastric Plexus Block, Ganglion Impar Block, Neuromodulation Techniques, Intraspinal Drug Delivery, Other Techniques, Vertebroplasty, Palliative Care

Excerpt:

"As discussed earlier, the barriers to effective pain control are multifold. As a result, clinicians have traditionally undertreated cancer pain. A growing recognition of this health issue has led to the development of numerous guidelines for treating cancer pain, including most famously the WHO stepladder approach to treating cancer pain. Although too simple to serve as a comprehensive treatment algorithm, the principle of treating more resistant cancer-related pain with stronger doses of opioids is generally sound (Table 94–3).Patients who fail to respond to conservative pharmacologic treatments may be candidates for interventional therapies. A large armamentarium of invasive procedures is available to achieve better control of cancer pain. However, the role of interventional therapies must be placed in the proper context. They cannot be used as the sole treatment of cancer pain, especially for advanced cancer patients. Rather, they should be used as part of a multimodality approach in the treatment of cancer pain.^35,36 The etiologies of cancer pain are diverse, and the pain symptom is interrelated with the constellation of symptoms experienced by cancer patients. Consequently, a global multimodal approach to treatment of cancer pain is necessary. It includes appropriate antineoplastic therapy, management of analgesics and adjuvant pain medications, behavioral and psychiatric support, and finally interventional therapies. Interventional pain procedures will not completely eliminate the need for pain medications. The..."

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