Availability of and factors related to interventional procedures for refractory pain in patients with cancer: a nationwide survey

Abstract

Background Cancer pain may be refractory to standard pharmacological treatment. Interventional procedures are important for quality of analgesia. The aim of the present study was to clarify the availability of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathecal analgesia), the number of procedures performed by specialists, and their associated factors. In addition, we aimed to establish how familiar home hospice physicians and oncologists are with the different interventional procedures available to manage cancer pain. Methods A cross-sectional survey using a self-administered questionnaire was conducted. Subjects were certified pain specialists, interventional radiologists, home hospice physicians, and clinical oncologists. Results The numbers of valid responses/mails were 545/1,112 for pain specialists, 554/1,087 for interventional radiology specialists, 144/308 for home hospice physicians, and 412/800 for oncologists. Among pain specialists, depending on intervention, 40.9-75.2% indicated that they perform each procedure by themselves, and 47.5-79.8% had not performed any of the procedures in the past 3 years. Pain specialists had performed the four procedures 4,591 times in the past 3 years. Among interventional radiology specialists, 18.1% indicated that they conduct celiac plexus neurolysis/splanchnic nerve neurolysis by themselves. Interventional radiology specialists had performed celiac plexus neurolysis/splanchnic nerve neurolysis 202 times in the past 3 years. Multivariate analysis revealed that the number of patients seen for cancer pain and the perceived difficulty in gaining experience correlated with the implementation of procedures among pain specialists. Among home hospice physicians and oncologists, depending on intervention, 3.5-27.1% responded that they were unfamiliar with each procedure. Conclusions Although pain specialists responded that the implementation of each intervention was possible, the actual number of the interventions used was limited. As interventional procedures are well known, it is important to take measures to ensure that pain specialists and interventional radiology physicians are sufficiently utilized to manage refractory cancer pain.

Upper thoracic spine puncture and caudal advance of an epidural catheter for adequate analgesia in a patient with breast cancer with chest and upper back pain: A case report

“…Epidural drug infusion therapy is one interventional approach. Most epidural analgesia procedures are performed with a catheter inserted in the lower thoracic or lumbar spine areas and then advanced in the cephalad direction ( 13 ). A previous case report described a patient with metastatic spinal cord compression who received cervical epidural analgesia due to neck pain ( 14 ).…”

Pancreatic cancer-related pain: mechanism and management

“…According to a nationwide survey in Japan, 47.5% to 79.8% pain specialists had not performed interventional procedures including CPN in the past 3 years, only 18.1% interventional radiology specialists indicated that they conducted CPN by themselves. [56] Several barriers existed for the implementation of the therapies. Studies showed that usually only pain specialists and interventional radiology physicians are able to provide CPN and SND, but a lack of time and training of experts are barriers to the implementation.…”