[Pain relief therapy for cancer pain (author's transl)]

A brief account is first given of the incidence and characteristics of cancer pain. The management of such pain should involve treatment of the malignant condition, psychological support, pharmacological supplementation and interruption of the pain pathways. The paper proceeds to detail the various methods by which this last objective can be achieved. The most widely applicable method is intrathecal injection of a neurolytic agent-phenol, chlorocresol or alcohol. This will provide 2-4 months relief in about 60 per cent patients. More prolonged and extensive relief can be done by cordotomy; the percutaneous procedure has the advantages of involving no general anaesthesia and only brief hospitalisation. For patients with hormone dependent tumours and those with widespread pain, relief can be obtained by destruction of the pituitary gland with absolute alcohol. The injection is carried out through a needle inserted into the gland via the nose and sphenoid sinus; one or two repeat injections may be necessary. When pain is partly due to involvement of autonomic nerves, it is necessary to carry out appropriate autonomic neurolysis, e.g. coeliac plexus block for visceral pain. Finally, the paper deals with non-invasive pain relief techniques, especially dorsal column and central nerve stimulation.