My Treatment: Cancer Pain - Treatment Options:Injections and Surgery

Interventional Techniques for Management of Pain

Neural Blockades. Nerves that conduct the sensation of pain can be blocked temporarily or permanently. Temporary nerve blocks use local anesthesia. Permanent blocks actually destroy nerves with heat, cold, alcohol or phenol. A local anesthetic block often is performed first so that a physician can gauge the approximate impact of the permanent block, and the patient can judge whether other effects—usually numbness—are tolerable. Sometimes, temporary blocks are used for intermittent relief, although this is less common in cancer pain.

Neurolytic Blocks. This approach stops the nerves' transmission of pain signals for a prolonged period of time. Although these blocks are called permanent, nerves can regenerate and cause pain again. For this reason, the relief to be gained from neurolytic blocks should be balanced against a person's life expectancy. There are several types of neurolytic blocks:

Peripheral nerve blocks are most commonly done on patients who have localized pain due to tumor invasion into the surrounding tissues innervated by the affected nerve.

Sympathetic nerve blocks are performed in different ways and for different areas of pain, including rectal pain, kidney pain, abdominal pain and pelvic pain.

Neuraxial (epidural or intrathecal) nerve blocks can be quite effective for most type of cancer pain that are not responsive to conventional opioid administration. It allows delivery of much reduced dose of opioids directly into the central nervous system, consequently, maximizing analgesic control and minimizing systemic side effects of the opioids. Most patients will undergo a trial evaluation for intrathecal opioid delivery. After the trial, patient can decide if a permanent implant of the infusion pump would be appropriate for his/her pain control.

Spinal Cord Stimulator. Very effective means of treating intractable pain non-responsive to pharmacologic and/or surgical modalities. Using electrode leads implanted into the epidural space connected to a impulse generator that is implanted under the gluteal fat pad to replace the painful sensation with a mild gentle tingling sensation.

Peripheral Nerve Stimulator. Similar concept as the spinal cord stimulator, but targeting to a specific peripheral nerve.

Vertebroplasty/ Kyphoplasty. Minimally invasive procedure performed to stabilize vertebral compression fractures and pain relieve by injecting cements into the fracture through the skin into the vertebra body using a needle.

Surgery

In cases where pain proves intractable, or difficult to treat, an operation may be performed to sever the nerves transmitting the pain signals. This is considered a treatment of last resort, since it can cause numbness or loss of motor and/ or sensory function.