Pain management for hepatobiliary cancer

Although many options exist to address hepatobiliary cancer-induced pain, it remains undertreated and has an adverse impact on quality of life. Fortunately, if addressed appropriately, the majority of patients can be treated successfully. This pain may be nociceptive, neuropathic, or a combination of the two. A multimodality approach including oral and intravenous opioid and non-opioid medications, and interventional approaches including celiac plexus blocks and implantation of drug delivery systems for intrathecal delivery of opioids can be considered and utilized as appropriate. We review the pathophysiology of pain, the approach to correctly diagnosing the different types of pain, the appropriate treatment recommendations, and how to avoid and address the common side effects resulting from these treatments.