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

Abstract

From this review, we identified a significant gap in research into the palliation of rectal tenesmus. A multimodal approach may be necessary due to the complexity of the pathophysiology of tenesmus. Future research should focus on randomised controlled trials of drug therapies whose potential effectiveness is suggested by case series.

<p>Rectal enema of bupivacaine in cancer patients with tenesmus pain – case series</p>

“…Pain is induced by a direct stimulation or damage of tissues and/or nerve fibers innervating pelvic organs. Pain may be persistent and unresponsive to typical pharmacology treatment with opioids and adjuvant analgesics 1,2,4…”

“…Cancer patients with tumours localized to the rectum, prostate in men, cervix in women, or lymph node metastases in the pelvis, infiltration of sacra bone, and/or the lower lumbar spine, may experience a very severe, often recurring pain, known as rectal tenesmus pain, which is not associated with the presence of stool in the rectum 1,2. Rectal tenesmus pain is not dependent on time of day, patient activity, or body position.…”

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

“…It represents a distressing symptom that significantly affects QoL. 83 The real incidence and prevalence of tenesmus among a cancer population, especially in the palliative care setting, remain unknown. In patients with recurrent rectal carcinoma, the reported prevalence is around 14%, 84 but there are few reported statistics about this symptom and probably the real prevalence may be higher.…”

“…Among clinical trials and systematic reviews, the primary outcome measure was reduction in severity of tenesmus (measured by numerical rating scales, categorical scales: complete, partial and no relief, reduced sensation to defaecate or a patient's account of improvement). 83…”

Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review

“…In addition to pelvic pain, this technique has also been used to manage tenesmus in the palliative patient. 38,54 Depending on the technique used, complications may include retroperitoneal hematoma, discitis (if utilizing a transdiscal approach), visceral injury, and damage to nerve roots. 47 Evidence regarding the efficacy of a superior hypogastric plexus block is limited, but it has been reported to provide effective pain relief and significantly reduce opioid requirements in more than 50% of patients.…”