CANCER PAIN MANAGMENT SERVICES
Why Is Cancer Pain Management Necessary?
Prevalence of pain in cancer patients is > 50%. As the disease progresses, severity of cancer pain increases to 58-69%. The objective is to provide a high-quality, pain-free life.
How Is Cancer Pain Controlled?
- Pharmacotherapy using the WHO analgesic step ladder strategy provides adequate pain management in the majority of cases up to the terminal stages.
- Titration of analgesic dosages is required based on the response.
- Patients with refractory cancer pain who are not alleviated by medication alone will require interventions at some point during the course of their disease.
- The psychological/spiritual/social causes of pain must also be addressed through communication skills, guidance, and counselling.
Integrated Cancer Pain And Palliative Care Services
- Cancer pain management - Pharmacotherapy via WHO analgesic step ladder
- Cancer pain management - MIPSI (minimally invasive pain and spine interventions) done under local anaesthesia
- Cancer pain management - Opioids and other adjuvant analgesics
- Cancer pain management - Advanced procedures - Intrathecal pump implantation, epidural pump implantation, spinal cord stimulator, percutaneous vertebroplasty
- Addressing challenging questions about advanced malignancies
- Supportive Care – Hospital based
- Hospice Care
- Respite Care
- Management of refractory cancer pain patients
- Management of symptom burden associated with any malignancy
- Anxiety/depression counselling for patients and family members
- End-of-life care for terminally ill patients
Cancer Pain Management Nerve Blocks (MIPSI)
- Head and neck cancer pain – Sphenopalatine ganglion, stellate ganglion block, glossopharyngeal block
- Mandibular or maxillary neuralgia – Gasserian ganglion block, peripheral nerve block
- Neck and shoulder pain – Cervical epidural, trigger point injections, ozone injection, suprascapular nerve radiofrequency, occipital nerve block and cervical medial branch block
- Chest and thoracic pain – Intercostal nerve block, paravertebral, epidural, erector spinae plane block, radiofrequency ablation
- Upper abdomen pain – Celiac neurolysis, splanchnic radiofrequency ablation
- Lower abdomen pain – Superior hypogastric neurolysis, caudal epidural, transversus abdominis plane block
- Perineal pain – Ganglion impar block, pudendal block
- Lower limb pain – Transforamen epidural, selective nerve root block
- Neuropathy pain – Lumbar sympathetic radiofrequency (lower limb) and T2-T3 sympathetic block (upper limb)
Common Cancer Pain Relief Sympathetic Nerve Block Procedures
- Celiac neurolysis/splanchnic radiofrequency ablation: cancer pain arising from pancreas, gallbladder, liver, stomach, omentum, mesentery, gut till transverse colon
- Superior hypogastric block: pain arising from uterus, ovary, cervix interstitial cystitis, neurogenic bladder, bladder tumour, descending colon, rectum, prostate, testis, epididymis
- Stellate ganglion block/T2-T3 radiofrequency ablation: pain due to brachial neuritis, lymphedema, pan brachial injury CRPS, some cancer pain of the head & neck and upper extremities
- T2-T3 radiofrequency ablation: cancer pain from structures like esophagus, heart, bronchi, trachea, lung, pleura and neuropathic pain involving thorax, chest wall, thoracic viscera & post herpetic neuralgia
- Ganglion impar block: sympathetic mediated pain of perineal region, malignancies of the pelvis or perineum, perineal neuralgia and coccydynia
Other Pain Management Services For
– Back pain
– Disc pain
– Prolapsed intervertebral disc (PIVD)
– Neck pain
– Arthritis
– Joint pain (Shoulder, elbow, wrist, hip, knee, ankle)
– Headache/Migraine
– Nerve pain
– Neuralgia like trigeminal/glossopharyngeal neuralgia
– Phantom limb pain
– Sympathetic pain
– Diabetic neuropathy
– Complex regional pain syndrome
– Peripheral vascular disease associated pain like Buerger’s disease or Raynauds phenomenon
Treatment Options For Other Painful Conditions
- Joint injections for arthritis
- Regenerative therapy for osteoarthritis [Platelet rich plasma PRP & Prolozone Dextrose therapy]
- Ozone administration – Anti-inflammatory
- Epidural (Caudal, transforamen, interlaminar) for back pain
- Vertebroplasty for spinal fractures
- Radiofrequency RFA [Pulsed RFA for prolapsed intervertebral disc causing nerve compression and Conventional RFA for sympathectomy procedure]
- Field blocks
- Peripheral nerve blocks