R Miguel1. 1. Anesthesiology Service, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
Abstract
BACKGROUND: For most patients with cancer pain, the World Health Organization's three-step analgesic ladder provides adequate management with oral or transdermal options. However, some cancer patients are not well palliated with these approaches. METHODS: The author reviews interventional options that include nerve blocks, spinal administration of local anesthetics, opioids, alpha-2 agonists, spinal cord stimulation, and surgical interventions. RESULTS: Numerous interventional options are readily accessible and most can be performed on an outpatient basis. They can be used as sole agents for the control of cancer pain or as useful adjuncts to supplement analgesia provided by opioids, thus decreasing opioid dose requirements and side effects. CONCLUSIONS: Cancer-related pain can be controlled with several interventions when oral or transdermal opioids are inadequate. A risk:benefit ratio should be considered before implementing invasive analgesic methods.
BACKGROUND: For most patients with cancer pain, the World Health Organization's three-step analgesic ladder provides adequate management with oral or transdermal options. However, some cancerpatients are not well palliated with these approaches. METHODS: The author reviews interventional options that include nerve blocks, spinal administration of local anesthetics, opioids, alpha-2 agonists, spinal cord stimulation, and surgical interventions. RESULTS: Numerous interventional options are readily accessible and most can be performed on an outpatient basis. They can be used as sole agents for the control of cancer pain or as useful adjuncts to supplement analgesia provided by opioids, thus decreasing opioid dose requirements and side effects. CONCLUSIONS:Cancer-related pain can be controlled with several interventions when oral or transdermal opioids are inadequate. A risk:benefit ratio should be considered before implementing invasive analgesic methods.
Authors: Pia Bader; Dieter Echtle; Valerie Fonteyne; Kostas Livadas; Gert De Meerleer; Alvaro Paez Borda; Eleni G Papaioannou; Jan H Vranken Journal: World J Urol Date: 2012-02-09 Impact factor: 4.226
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Authors: Adam Hurlow; Michael I Bennett; Karen A Robb; Mark I Johnson; Karen H Simpson; Stephen G Oxberry Journal: Cochrane Database Syst Rev Date: 2012-03-14