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Interventional Pain
Management in Cancer
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Interventional Pain
Management
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Botulinum Toxin
Acupuncture
Local Blockade
Sympathetic Blocks
Spinal Procedures
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Botulinum Toxin
• Treatment for spasticity,
musculoskeletal pain, muscle
spasms and neuropathic pain.
• Block the release of pain
mediators
• Radiation induced myokimia
and spasticity
• Reduced postoperative pain
after mastectomy
• Reduce pain in muscle spasm
after radiotherapy in patients
with head
and neck cancer.
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Botulinum Toxin
• Radiation fibrosis syndrome
• Radiation induced dystonia,
trigeminal neuralgia, cervical
plexus neuralgia
• No standard guidelines
– Low dose  100-300 units per
treatment
• Relief: 6-12 weeks
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Acupuncture
• Stimulating specific
discrete anatomic
points
• Adjunct for pain
control, nausea,
vomiting postchemotherapy, back
pain
• Short term pain relief
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Local Blockade
• Local anesthetics
• Done before proceeding to
neurolysis
• Neurolysis:
– Intercostal nerves
– Cutaneous sensory nerves
(trigeminal and saphenous)
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Local Blockade
• Neurolysis:
– Freezing
• Application of subzero temperatures
• Ice crystals create vascular damage
to the vasa nervorum
• Used in trigeminal neuralgia and
intercostal nerves
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Local Blockade
• Neurolysis:
– Heating
• Radiofrequency ablation (RF)
– Sacroiliac pain, trigeminal neuralgia
– Chemical Techniques
• Phenol or ethanol preparations
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Sympathetic Blocks
• Superior hypogastric plexus
– Mainly for chronic pelvic cancer
pain
• Celiac Plexus
– Cancer of the abdominal viscera
– May cause hypotension and
diarrhea.
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Spinal Procedures
• Epidural Steroid Injections
– Acute radicular pain due to
herniated nucleus pulposus.
– Earlier pain relief and return to
function.
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Spinal Procedures
• Vertebral Procedures
– Tumor involvement of vertebra
– Kyphoplasty
• Balloon expansion of the vertebrae
– Vertebroplasty
• Introduces cement to damage
vertebra
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Spinal Procedures
• Facet Arthropathy
– Osteoarthiritis and tumor
– Intraarticular injection of steroids
– Radiofrequency ablation
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Complementary
Therapies for Pain
Management in
Cancer
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Complementary Therapies
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Acupuncture
Massage Therapy
Hypnosis
Music Therapy
Dietary Supplements
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Acupuncture
• Induce analgesics
effect
• Studies:
– Showed improvement
– Short term pain relief
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Massage Therapy
• Stretch and compress a
patient’s muscle &
connective tissue.
• Increased circulation
• Stimulation of lymphatic
damage
• Improve muscle tissue
metabolism and elasticity
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Massage Therapy
• Reduce anxiety, emotional
stress, fatigue.
• Effect on physical
symptoms
• Reduce patient’s need for
NSAIDs
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Hypnosis
• Altered state of
consciousness
• A state between
wakefulness and
sleep
• Control of his
behavior
• Hypnotic analgesia
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Music Therapy
• Ease pain, anxiety
and depression
• Decreased opioid
requirement  further
study
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Herbal Remedies
• Should be cautious
• Musculoskeletal pain and
arthritic conditions 
glucosamine
• Glutamine  reducing
peripheral neuropathy;
dec toxicity of
chemotherapy and
radiation
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Thank you...
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