Interventional Therapies to Treat Cancer Associated Pain.

opinion statementCancer associated pain (CAP) is challenging to treat and may be complicated by type of cancer, location, presence of metastases, cancer therapies, medical co-morbidities, psychosocial factors, and barriers to treatment. Inadequate CAP management can lead to delays in receiving chemo/radiation therapy, and medications or interventions that provide analgesia. In this narrative review, we aim to provide an evidence-based overview of current and emerging interventional pain techniques used to manage CAP. Intractable visceral cancer pain refractory to conservative medical management can be targeted with ganglion plexus block/neurolysis at the celiac plexus, splanchnic nerve, superior hypogastric plexus, or ganglion impar. Chest wall pain secondary to cancer may benefit from intercostal nerve block or peripheral nerve ablation. Meanwhile, soft tissue pain can be targeted with cryoablation and high intensity focused ultrasound therapies. Vertebral augmentation can be used to treat cancer-related compression fractures. Neuromodulation such as spinal cord stimulation, dorsal root ganglion stimulation, and peripheral nerve stimulation are emerging tools that have been shown to be effective in managing neuropathy and mechanical axial spine CAP. Lastly, the intrathecal drug delivery system has been a mainstay in CAP treatment, especially in patients who cannot tolerate the side effects of oral and intravenous opioids. It has been argued that to effectively manage CAP, interventional procedures should be offered concurrently with conservative medical management.