Interventional Modalities to Treat Cancer-Related Pain

Abstract

Cancer-related pain is a significant cause of morbidity in those affected by both primary and metastatic disease. Although oral, transdermal, and parenteral opioid medications are an integral part of the World Health Organization's analgesic ladder, their use may be limited by side effects. Fortunately, there are advanced interventional pain management strategies effective in reducing pain in the cancer patient while mitigating the aforementioned side effects. Celiac plexus blocks and neurolysis have been proven effective in treating cancers of the abdominal viscera (ie, pancreas). Transversus abdominis plane blocks, neurolysis, and catheter placement can be used to treat cancer pain associated with the abdominal wall. Peripheral nerve blocks and catheter placement at the brachial and lumbosacral plexus or peripheral nerves treat cancer pain associated with the upper and lower limbs, whereas paravertebral and intercostal blocks treat cancer pain associated with the chest wall and ribs. Finally, alternate drug delivery methods such as intrathecal drug delivery systems concentrate medication at central opioid receptors without affecting the peripheral receptors implicated in unwanted side effects. This article provides an overview of these interventions, including indications, contraindications, and potential complications of advanced interventional pain management options available for the treatment of intractable cancer-related pain.

Pain Outcomes in Patients Undergoing CT-Guided Celiac Plexus Neurolysis for Intractable Abdominal Visceral Pain

“…1 –3 Celiac plexus neurolysis may be carried out via guidance with fluoroscopy, 4 endoscopic ultrasound, 5 magnetic resonance imaging, 6 or computed tomography (CT). 1,7 –10 Although each of these modalities exhibits unique advantages and disadvantages, 1 CT guidance has been adopted in the interventional radiology community as being particularly advantageous for clearly visualizing retroperitoneal structures and tumor involvement, locating the needle tip, and avoiding damage to vital organs and vessels. 1,7,8,11…”

Bleeding Complications in Patients Undergoing Celiac Plexus Block

“…The procedures were performed via a retrocrural approach, which has been previously described. 13 Before needle placement, advanced imaging such as a computed tomographic scan of the abdomen is reviewed by the proceduralist to anticipate any unexpected anatomy, as displacement of vascular structures may occur secondary to significant tumor burden.…”

Interventional Techniques for the Management of Cancer-Related Pain: Clinical and Critical Aspects

“…Contraindications to neuraxial therapy may exist in fragile patients, and complications of varying severity are described in the literature [4]. They include harm to spinal cord or fibers during punction and catheter placement, headache after dural puncture, epidural hematoma, infections, meningitis, and catheter migration, among others [13]. Therefore, a limited number of patients with cancer-related pain are candidates for neuraxial therapy, which also reflects the difficulties in performing high quality RCTs.…”