Pain in Patients with Cancer

Kris C.P. Vissers*, Kees Besse, Michel Wagemans, Wouter Zuurmond, Maurice J.M.M. Giezeman, Arno Lataster, Nagy Mekhail, Allen W. Burton, Maarten van Kleef, Frank J.P.M. Huygen

*Corresponding author for this work

Research output: Chapter/Conference proceedingChapterAcademic

3 Citations (Scopus)

Abstract

Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancer patients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordotomy may be considered for patients suffering with unilateral pain at the level below the dermatome C5. This technique should only be applied in patients with a life expectancy of less than 1 year. Plexus coeliacus block or nervus splanchnicus block are recommended for the management of upper abdominal pain due to cancer. Pelvic pain due to cancer can bemanaged with plexus hypogastricus block and the saddle or lower end block may be a last resort for patients suffering with perineal pain. Back pain due to vertebral compression fractures with or without pathological tumor invasion may be managed with percutaneous vertebroplasty or kyphoplasty. All these interventional techniques should be a part of multidisciplinary patient program.

Original languageEnglish
Title of host publicationEvidence-Based Interventional Pain Medicine
Subtitle of host publicationAccording to Clinical Diagnoses
PublisherWiley-Blackwell
Pages173-190
Number of pages18
ISBN (Print)9780470671306
DOIs
Publication statusPublished - 1 Nov 2011

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