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Review
. 2023 May 18:16:1663-1671.
doi: 10.2147/JPR.S405808. eCollection 2023.

Early Interventional Treatments for Patients with Cancer Pain: A Narrative Review

Uri Hochberg  1 , Pablo Ingelmo  2   3   4 , Ester Solé  5 , Jordi Miró  5   6 , Gonzalo Rivera  7   8 , Jordi Perez  2   3   9
Affiliations
Review

Early Interventional Treatments for Patients with Cancer Pain: A Narrative Review

Uri Hochberg et al. J Pain Res. .

Abstract

Between 10% and 20% of patients with cancer-related pain cannot achieve adequate control following the three-step ladder guidelines by the World Health Organization. Therefore, a "fourth step", including interventional approaches, has been suggested for those cases. Systematic reviews support the early use of interventional procedures to treat refractory cancer pain, control symptoms and prevent opioid dose escalation. There is strong evidence of the efficacy of celiac plexus or splanchnic neurolysis, vertebroplasty, kyphoplasty and intrathecal drug delivery. Those procedures have been found to be associated with a decrease in the symptom burden and opioid consumption, improved quality of life, and suggested as having a potentially positive impact on survival. Several studies have recommended using specific interventional techniques at earlier stages, possibly even when opioid treatment is first being considered. Conversely, leaving these options as a last analgesic resource might not be advisable since the burden these procedures might impose on too ill patients is significant. The objective of this review was to collect the available evidence published on the use of interventional treatments for refractory cancer pain with a particular interest in comparing early versus late indications. The results of the search demonstrated a very low number and quality of articles particularly addressing this question. This scarce number of evidence precluded performing a systematic analysis. A detailed and narrative description of the potential benefits of integrating interventional techniques into clinical guidelines at the early stages of the disease is provided.

Keywords: cancer pain; cement augmentation; early; interventional pain; intrathecal drug delivery; neurolysis; timing.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Celiac plexus neurolysis in a patient with pancreatic cancer-related abdominal pain.
Figure 2
Figure 2
Superior hypogastric plexus neurolysis in a patient with ovarian cancer-related pelvic pain.
Figure 3
Figure 3
Percutaneous vertebroplasty in a patient with low back pain related to vertebral fracture.
Figure 4
Figure 4
Intrathecal catheter connected to an implanted pump.
Figure 5
Figure 5
Interventional approaches as the handrail to the WHO ladder.
See this image and copyright information in PMC

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References

    1. Mantyh PW. Cancer pain and its impact on diagnosis, survival and quality of life. Nat Rev Neurosci. 2006;7(10):797–809. doi:10.1038/nrn1914 - DOI - PubMed
    1. Gagliese L, Gauthier LR, Rodin G. Cancer pain and depression: a systematic review of age-related patterns. Pain Res Manag. 2007;12(3):205–211. doi:10.1155/2007/150126 - DOI - PMC - PubMed
    1. Miladinia M, Baraz S, Ramezani M, Malehi AS. The relationship between pain, fatigue, sleep disorders and quality of life in adult patients with acute leukaemia: during the first year after diagnosis. Eur J Cancer Care. 2018;27(1):e12762. doi:10.1111/ecc.12762 - DOI - PubMed
    1. Miguel R. Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder? Cancer Control. 2000;7(2):149–156. doi:10.1177/107327480000700205 - DOI - PubMed
    1. Vissers KCP, Besse K, Wagemans M, et al. Pain in patients with cancer. Pain Pract. 2011;11(5):453–475. doi:10.1111/j.1533-2500.2011.00473.x - DOI - PubMed