[Pain therapy in tumor patients and in palliative medicine. 2: Invasive measures]

Anesthesiological and neurosurgical methods in the treatment of cancer pain have to be considered as parts of a holistic approach. To treat cancer pain patients appropriately, an interdisciplinary setting is essential. In the eyes of experienced pain specialists as well as physicians in palliative medicine invasive procedures are only of minor importance. Their use has been steadily decreasing while neuromodulatory (e.g. intraspinal opioids) or stimulatory (e.g. TENS, DBS, SCS) methods gained wider acceptance. The only neurolytic procedure which still has some importance is the neurolysis of the celiac ganglion for alleviation of pain in the upper abdomen mostly due to pancreatic cancer. This approach seems to be highly effective and tends to be afflicted with only minor complications. Other neurolytic blocks have shown solely local and temporal efficacy. In their majority they are unprecise and often accompanied by severe complications. Therefore these procedures should be scheduled only after carefully weighing risk versus benefit. Where suitable, the use of neurolytics is replaced by radiofrequency thermocoagulation, to a lesser degree by cryoanalgesia. Both procedures normally do not yield better analgesia but do result in fewer complications. Physicians tend to treat pain as a completely somatic disorder, but chronic pain states are always bio-psycho-social in nature. In order to achieve an effective pain treatment all influencing variables have to be taken into account. Anesthesiological and neurosurgical procedures are only a part of the possible and necessary treatment options. Especially before using one of the invasive methods described here, it seems imperative to involve the patient in the process of decision making more closely than currently practiced.