The Missing Link: Integrating Interventional Pain Management in the Era of Multimodal Oncology

Abstract

Cancer-related pain (CrP) is one of the most frequent and debilitating issues that affect the quality of life of patients with cancer. Systemic analgesics, particularly opioids, have been the cornerstone of pain management. However, the following shortcomings of the mentioned therapies, such as side effects, tolerance, and inadequate relief in refractory cases, make implementing a more complete, multimodal treatment plan necessary. Interventional pain management (IPM) uses specific invasive procedures, with different degree of invasiveness, such as nerve blocks, neurolysis, neuromodulation, and intrathecal drug delivery systems to provide effective pain relief with reduced adverse effects compared with opioids. These approaches are frequently underutilized due to delayed referrals, insufficient awareness, and logistic inefficiencies, which delay access to pain management centers specializing in care for patients in pain. Recent technological advancements offer the potential to overcome these barriers, including artificial intelligence-driven decision support systems and automated referral pathways, enabling early intervention and individualized pain treatment plans. The future of CrP management should shift from the current reactive model to a proactive approach, enabling the earlier incorporation of interventional techniques into treatment plans. The integration of interdisciplinary collaboration and technological innovations will enhance cancer pain management and progress from current outdated approaches to provide more effective and timely pain relief for patients with chronic refractory cancer pain.

Keywords: Cancer pain; Epidural analgesia; Intrathecal injections; Nerve block; Neurolysis; Palliative care; Radiofrequency ablation; Spinal cord stimulation; Vertebroplasty.

Fig. 1

Crossroad of cancer-related pain (CrP). Each patient with CrP reaches a crossroad where different therapeutic paths can be taken. The four gears represent the main approaches: interventional (green), pharmacological with NSAIDs, opioids, and adjuvants (red), supportive therapies such as nutrition and physiotherapy (blue), and psychological therapy (yellow). The central lever signifies key factors such as disease progression, treatment side effects, or end-of-life status, which can shift the chosen approach when operated by the clinician. The winding road reflects the patient’s dynamic journey through these treatments, ensuring a personalized and adaptive pain management strategy

Fig. 2

Fluoroscopic image showing dorsal root ganglion (DRG) stimulation with two electrode leads positioned at the L3 and L4 ganglia. The patient, a cancer survivor, presented with chronic cancer-related pain (CrP) and right-sided gonalgia due to complex regional pain syndrome (CrPS). DRG stimulation was selected over conventional spinal cord stimulation (SCS) due to its ability to provide highly focal, segmental pain control, which is particularly advantageous in localized, mixed neuropathic pain syndromes