Interventional treatment of refractory cancer pain

Recent advances in medical science have prolonged the life expectancy for many cancer patients. However, many studies demonstrate that cancer pain is a symptom for two thirds of patients in the advanced stages of the disease and nearly universal in the last 48 hours of life. Whereas most cancer patients can be effectively treated with conventional analgesics, 10% to 15% of patients require additional, and sometimes invasive, therapy. The most commonly used procedures for the treatment of this refractory cancer pain is the topic of review in this paper. Neurolytic blocks, such as celiac plexus and ganglion of impar block, are still used in the management of pain related to abdominal and pelvic cancers. Nondestructive interventional techniques include the use of epidural and intrathecal spinal analgesics. The efficacy, recommended medications, and adverse effect profile of these therapies are reviewed.