Dr. Aabaji Thatte Seva Aur Anusandhan Sanstha
By Dr. Sachin Jambhorkar
National Cancer Institute, Nagpur
On 01 August 2018
Pain is one of the most common symptoms experienced by cancer patients around the world at some point during the course of their illness. Prevalence can range from 40% to as high as 90% with advanced disease. Cancer pain is complex and multi-factorial. Pain can be due to cancer at the primary site, from areas of metastases, its treatment or to another condition.
Most cancer pain (80-90%) can be effectively controlled using conventional systemic analgesics and adjuvant. But some cancer patients can suffer from intolerable adverse effects of drug therapy or intractable cancer pain in advanced disease. These patients may benefit from some form of interventional strategies for pain management.
The pain relief, reduced medical cost, and improvement in function and quality of life from a wide variety of available interventional procedures is extremely invaluable.
These techniques may vary from simple nerve blocks to more invasive neurosurgical procedures. At our center, we frequently use:-
l) Central Neuraxial Blockade: - Which includes epidural and intrathecal drug infusions, intrathecal drug delivery (ITDD) systems, Epidural or intrathecal Neurolysis etc.
2) Sympathetic blocks like The Ganglion Impar Block For localized pain in the perineum, like in anal and vaginal cancer pain. In these patients oral morphin aggrevates constipation and thereby increases suffering. By giving ganglion Impar Block this side effect is nullified and the pt has normal defecation without pain.
3) Peripheral nerve Blocks:- These are useful when Cancer pain occurs in the territory of one or more peripheral nerves. Neuroloytic agents like alcohol or phenol are commonly used for peripheral nerve blocks. Various peripheral nerve blocks include –
a) Glossopharyngeal nerve Block: for Patients with carcinoma tongue throat, ear and tonsils. b) Mandibular and Maxillary nerve Block:- For oral cancer patients.
The origin of pain and the life expectancy of the cancer patient is an important consideration for selection of an appropriate interventional technique.
Although not without risks, appropriately chosen interventional pain procedures may well have a positive impact on the course of the disease and result in improvement in function and quality Of life terminally Ill cancer patients.