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16 - Neural blockade for cancer pain

from SECTION V - OTHER INTERVENTIONAL STRATEGIES

Published online by Cambridge University Press:  06 July 2010

By
REBECCA CHAN  and
OSCAR DE LEON-CASASOLA
Edited by
Eduardo D. Bruera  and
Russell K. Portenoy
REBECCA CHAN
Affiliation:
University of Illinois College of Medicine
OSCAR DE LEON-CASASOLA
Affiliation:
Roswell Park Cancer Institute
Eduardo D. Bruera
Affiliation:
University of Texas, Houston
Russell K. Portenoy
Affiliation:
Albert Einstein College of Medicine, New York
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Summary

Background

Cancer pain is the result of cancer growth in human tissues, or the pain produced by any of the therapies implemented to treat it. The ideal management starts with a thorough assessment via history and physical examination, as well as the judicious use of diagnostic testing to try to define the pathophysiological components involved in the expression of pain to implement optimal analgesic therapy. Adequate pain control can be achieved in a majority of patients with the implementation of an aggressive pharmacological treatment with the use of opioids and adjuvants. With the implementation of these strategies, 90%–95% of patients may achieve adequate pain control. Consequently, 5%–10% of patients will need some form of invasive therapy. Thus, when following specific guidelines, a majority of patients with cancer-related pain may expect adequate pain control in the 21st century. Control of pain and its related symptoms is a cornerstone of cancer treatment, as it promotes an enhanced quality of life, improved functioning, better compliance, and a way for patients to focus on the things that give meaning to life. In addition to their salutary effects on quality of life, mounting evidence suggests that good pain control influences survival (see Table 16.1).

Classification of cancer pain

In the evaluation of a patient with cancer pain, it is important to obtain a history with the framework of four broad categories in mind: time course, intensity, pathophysiology, and the temporal aspect.

Type
Chapter
Information
Cancer Pain
Assessment and Management
 , pp. 315 - 328
Publisher: Cambridge University Press
Print publication year: 2009

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References

,American Pain Society. Principles of analgesic use in the treatment of acute pain and chronic cancer pain, 3rd ed. Skokie, IL: APS, 1992.Google Scholar
Jacox, A, Carr, DB, Payne, R, et al. Management of cancer pain: clinical practice guideline 9. Agency for Health Care Policy and Research pub. 94-0592. Rockville, MD: ACHPR, 1994.Google Scholar
Zech, DFG, Grong, S, Lynch, J, et al. Validation of the World Health Organization guidelines for cancer pain relief: a 10-year prospective study. Pain 63:65–76, 1996.CrossRefGoogle Scholar
Ferrell, BR, Wisdon, C, Wenzl, C. Quality of life as an outcome variable in management of cancer pain. Cancer 63:2321, 1989.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Liebeskind, JC. Pain can kill. Pain 44:3–4, 1991.CrossRefGoogle Scholar
Lillemoe, KD, Cameron, JL, Kaufman, HS, et al. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. Ann Surg 217:447–57, 1993.CrossRefGoogle ScholarPubMed
Sternbach, RA. Pain: a psychophysiological analysis. New York: Academic Press, 1968.Google Scholar
Newman, PP. Visceral afferent functions of the nervous system. London: Arnold, 1974.Google Scholar
Procacci, P, Maresca, M. Pathophysiology of visceral pain. Adv Pain Res Ther 13:123, 1990.Google Scholar
Kellgren, JH. Somatic simulating visceral pain. Clin Sci 4:303, 1939.Google Scholar
Cervero, F. Visceral pain. In: Dubner, R, Gebhart, GF, Bond, MR, eds. Proceedings of the VI World Congress on Pain. Amsterdam: Elsevier, 1988, p 216.Google Scholar
Cousins, MJ, Mather, . Intrathecal and epidural administration of opioids. Anesthesiology 61:276–310, 1984.Google ScholarPubMed
Crawford, ME, Andersen, HB, Augustenborg, G, et al. Pain treatment on outpatient basis using extradural opiates: Danish multicenter study comprising 105 patients. Pain 16:41, 1983.CrossRefGoogle ScholarPubMed
Yaksh, TL. Spinal opiates: a review of their effect on spinal function with an emphasis on pain processing. Acta Anaesthesiol Scand 31(Suppl 85):25, 1987.CrossRefGoogle Scholar
Snyder, SH. Opiate receptors in the brain. N Engl J Med 296:266–71, 1977.CrossRefGoogle Scholar
Du Pen, S, Kharasch, ED, Williams, A, et al. Chronic epidural bupivacaine-opioid infusion in intractable cancer pain. Pain 49:293–300, 1992.CrossRefGoogle ScholarPubMed
Smith, TJ, Staats, PS, Deer, T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol 20:4040–9, 2002.CrossRefGoogle Scholar
Burton, AW, et al. Reduction in pain and oral opioid intake following intrathecal pump implantation. Presented at the World Congress of Pain. San Diego, CA, August 2002.Google Scholar
Bedder, MD, Burchiel, KJ, Larson, A. Cost analysis of two implantable narcotic delivery systems. J Pain Symptom Manage 6:368, 1991.CrossRefGoogle ScholarPubMed
Hassenbusch, SJ, Bedder, M, Patt, RB, Bell, GK. Current status of intrathecal therapy for nonmalignant pain management: clinical realities and economic unknowns. J Pain Symptom Manage 14:S36–48, 1997.CrossRefGoogle Scholar
Hassenbusch, SJ, Portenoy, RK. Current practices in intraspinal therapy – a survey of clinical trends and decision making. J Pain Symptom Manage 20:S4–11, 2000.CrossRefGoogle ScholarPubMed
Bonica, JJ. Management of pain. Philadelphia: Lea & Febiger, 1953.Google Scholar
Cousins, MJ. Anesthetic approaches in cancer pain. Adv Pain Res Ther 16:249–73, 1990.Google Scholar
Raj, P, Ramamurthy, S. Differential nerve block studies. In: Raj, P, ed. Practical management of pain. Chicago: Year Book, 1986, pp 173–7.Google Scholar
Abram, SE. The role of nonneurolytic nerve blocks in the management of cancer pain. In: Abram, SE, ed. Cancer pain. Amsterdam: Kluwer, 1989, pp 67–75.CrossRefGoogle Scholar
Travel, JG, Simons, DG. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins, 1983.Google Scholar
Payne, R. Neuropathic pain syndromes, with special reference to causalgia and reflex sympathetic dystrophy. Clin J Pain 2:59–73, 1986.CrossRefGoogle Scholar
Gerbershagen, HU. Blocks with local anesthetics in the treatment of cancer pain. In: Bonica, JJ, Ventafridda, V, eds. Advances in pain research and therapy, vol. 2. New York: Raven Press, 1979, pp 311–23.Google Scholar
Warfield, CA, Crews, DA. Use of stellate ganglion blocks in the treatment of intractable limb pain in lung cancer. Clin J Pain 3:13, 1987.CrossRefGoogle Scholar
Evans, PJD. Cryoanalgesia. Anaesthesia 36:1003–13, 1981.CrossRefGoogle ScholarPubMed
Doyle, D. Nerve blocks in advanced cancer. Practitioner 226:539–44, 1982.Google ScholarPubMed
Ischia, S, Ischia, A, Polati, E, et al. Three posterior percutaneous celiac plexus block techniques: a prospective randomized study in 61 patients with pancreatic cancer pain. Anesthesiology 76:534–40, 1992.CrossRefGoogle ScholarPubMed
Wong, G, Schoeder, DR, Carns, PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer. JAMA 291:1092–9, 2004.CrossRefGoogle ScholarPubMed
Rykowski, JJ, Hilgier, M. Continuous celiac plexus block in acute pancreatitis. Reg Anesth 20:528–32, 1995.Google ScholarPubMed
,Regional anesthetic techniques for the management of cancer pain. In: Urmey, W, ed. Techniques in regional anesthesia and pain management, vol. 1, no. 1. Philadelphia: W. B. Saunders, 1997.Google Scholar
Singler, RC. An improved technique for alcohol neurolysis of the celiac plexus block. Anesthesiology 56:137–41, 1982.CrossRefGoogle Scholar
Hilgier, M, Rykowski, JJ. One needle transcrural celiac plexus block: single shot, or continuous technique, or both. Reg Anesth 19:277–83, 1994.Google ScholarPubMed
Ischia, S, Luzzani, A, Ischia, A, et al. A new approach to the neurolytic block of the coeliac plexus: the transaortic technique. Pain 16:333–41, 1983.CrossRefGoogle ScholarPubMed
Davis, DD. Incidence of major complications of neurolytic coeliac plexus block. J R Soc Med 86:264–6, 1993.Google Scholar
Wong, GY, Brown, DL. Celiac plexus block for cancer pain. In: Urmey, W, ed. Tech reg anesth pain manage, vol. 1, no. 1. Philadelphia: W. B. Saunders, 1997.Google Scholar
Hanley, JA, Lippman-Hand, A. If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA 249:1743–5, 1983.CrossRefGoogle ScholarPubMed
Matson, JA, Ghia, JN, Levy, JH. A case report of a potentially fatal complications associated with Ischia's transaortic method of celiac plexus block. Reg Anesth 10:193–6, 1985.Google Scholar
Sett, SS, Taylor, DC. Aortic pseudoaneurysm secondary to celiac plexus block. Ann Vasc Surg 5:88–91, 1991.CrossRefGoogle ScholarPubMed
Kaplan, R, Schiff-Keren, B, Alt, E. Aortic dissection as a complication of celiac plexus block. Anesthesiology 83:632–5, 1995.CrossRefGoogle ScholarPubMed
Galizia, EJ, Lahiri, SK. Paraplegia following coeliac plexus block with phenol. Case report. Br J Anaesth 46:539–40, 1974.CrossRefGoogle ScholarPubMed
Lo, JN, Buckley, JJ. Spinal cord ischemia a complication of celiac plexus block. Reg Anesth 7:66–8, 1982.Google Scholar
Cherry, DA, Lamberty, J. Paraplegia following coeliac plexus block. Anaesth Intensive Care 12:59–61, 1984.Google ScholarPubMed
Woodham, MJ, Hanna, MH. Paraplegia after coeliac plexus block. Anaesthesia 44:487–9, 1989.CrossRefGoogle ScholarPubMed
Dongen, RT, Crul, BJ. Paraplegia following coeliac plexus block. Anaesthesia 46:862–3, 1991.CrossRefGoogle ScholarPubMed
Jabbal, SS, Hunton, J. Reversible paraplegia following coeliac plexus block. Anaesthesia 47:857–8, 1992.CrossRefGoogle ScholarPubMed
Wong, GY, Brown, DL. Transient paraplegia following alcohol celiac plexus block. Reg Anesth 20:352–5, 1995.Google ScholarPubMed
Brown, DL, Rorie, DK. Altered reactivity of isolated segmental lumbar arteries of dogs following exposure to ethanol and phenol. Pain 56:139–43, 1994.CrossRefGoogle ScholarPubMed
Mercadante, S. Celiac plexus block versus analgesics in pancreatic cancer pain. Pain 52:187–192, 1993.CrossRefGoogle ScholarPubMed
Cicco, M, Matovic, M, Bortolussi, R, et al. Celiac plexus block: injectate spread and pain relief in patients with regional anatomic distortions. Anesthesiology 94:561–5, 2001.CrossRefGoogle ScholarPubMed
Ventafridda, GV, Caraceni, AT, Sbanotto, AM, et al. Pain treatment in cancer of the pancreas. Eur J Surg Oncol 16:1–6, 1990.Google ScholarPubMed
Eisenberg, E, Carr, DB, Chalmers, TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg 80:290–5, 1995.Google ScholarPubMed
Yeager, MP. Morphine inhibits spontaneous and cytokine-enhanced natural killer cell cytotoxicity in volunteers. Anesthesiology 83:500–8, 1995.CrossRefGoogle ScholarPubMed
Lillemoe, KD, Cameron, JL, Kaufman, HS, et al. Chemical splanchnicectomy in patients with unresectable pancreatic cancer: a prospective randomized trial. Ann Surg 217:447–57, 1993.CrossRefGoogle ScholarPubMed
Plancarte, R, Amescua, C, Patt, RB, et al. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology 73:236–9, 1990.CrossRefGoogle ScholarPubMed
Leon-Casasola, OA, Kent, E, Lema, MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain 54:145–51, 1993.CrossRefGoogle ScholarPubMed
Plancarte, R, de Leon-Casasola, OA, El-Helaly, M, et al. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth 22:562–8, 1997.Google ScholarPubMed
Rosenberg, SK, Tewari, R, Boswell, MV, et al. Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate. Reg Anesth Pain Med 23:618–20, 1998.CrossRefGoogle ScholarPubMed
Plancarte, R, Amescua, C, Patt, RB. Presacral blockade of the ganglion of Walther (ganglion impar). Anesthesiology 73:A751, 1990.CrossRefGoogle Scholar
Nebab, EG, Florence, IM. An alternative needle geometry for interruption of the ganglion impar. Anesthesiology 86:1213–14, 1997.CrossRefGoogle ScholarPubMed
Wemm, KJ, Sabersky, L. Modified approach to block the ganglion impar (ganglion of Walther). Reg Anesth 20:544–5, 1995.Google Scholar
Loev, MA, Varklet, VL, Wilsey, BL. Cryoablation: a novel approach to neurolysis of the ganglion impar. Anesthesiology 88:1391–3, 1998.CrossRefGoogle ScholarPubMed
Plancarte, R, Velazquez, R, Patt, RB: Neurolytic blocks of the sympathetic axis. In: Patt, RB, ed. Cancer pain. Philadelphia: Lippincott-Raven, 1993, p 419.Google Scholar
Swofford, JB, Ratzman, DM. A transarticular approach to blockade of the ganglion impar (ganglion of walther). Reg Anesth Pain Med 23(3 Suppl):103, 1998.CrossRefGoogle Scholar
Vranken, JH, Bannink, IMJ, Zuurmond, WWA: Invasive procedures in patients with coccygodynia: caudal epidural infiltration, pudendal nerve block and blockade of the ganglion impar. Reg Anesth Pain Med 25(2 Suppl):25, 2000.Google Scholar
Peyton, WT, Semansky, EJ, Baker, AB. Subarachnoid injection of alcohol for relief of intractable pain with discussion of cord changes found at autopsy. Am J Cancer 30:709, 1937.Google Scholar
Smith, MC. Histological findings following intrathecal injections of phenol solutions for relief of pain. Br J Anaesth 36:387–406, 1963.CrossRefGoogle Scholar
Swerdlow, M. Intrathecal neurolysis. Anaesthesia 33:733–40, 1978.CrossRefGoogle ScholarPubMed
Katz, J. The current role of neurolytic agents. Adv Neurol 4:471–6, 1974.Google Scholar
Swerdlow, M. Subarachnoid and extradural blocks. Adv Pain Res Ther 2:325–37, 1979.Google Scholar
Hay, RC. Subarachnoid alcohol block in the control of intractable pain. Anesth Analg 41:12–16, 1962.CrossRefGoogle ScholarPubMed
Stovner, J, Endresen, R. Intrathecal phenol for cancer pain. Acta Anaesthesiol Scand 16:17–21, 1972.CrossRefGoogle ScholarPubMed
Holland, AJC, Youssef, M. A complication of subarachnoid phenol blockade. Anaesthesia 34:260–2, 1979.CrossRefGoogle ScholarPubMed
Racz, GB, Heavner, J, Haynsworth, R. Repeat epidural phenol injections in chronic pain and spasticity. In: Lipton, S, Miles, J, eds. Persistent pain, vol. 5. Orlando: Grune & Stratton, 1985, pp 157–79.Google Scholar
Madrid, JL, Bonica, JJ. Cranial nerve blocks. In: Bonica, JJ, Ventafridda, V, ed. Advances in pain research and therapy, vol. 2. New York: Raven Press, 1979, pp 463–8.Google Scholar
Waldman, SD, Feldstein, GS, Allen, ML, et al. Cervical epidural implantable narcotic delivery systems in the management of upper body pain. Anesth Analg 66:780–2, 1987.CrossRefGoogle Scholar
Lobato, RD, Madrid, JL, Fatela, LV, et al. Intraventricular morphine for intractable cancer pain: rationale, methods, clinical results. Acta Anaesthesiol Scand 31:68–74, 1987.CrossRefGoogle Scholar

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