From the Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, UT
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Perry Fine, MD, University of Utah Pain Research Center, Suite 200, 615 Arapeen Drive, Salt Lake City, UT 84108; e-mail: perry.fine{at}hsc.utah.edu
Overview: Interventional therapies are underutilized in the treatment of patients with cancer-related pain. When the World Health Organization analgesic ladder approach to treatment is inadequate or poorly tolerated, alternatives to basic pharmacotherapy should be considered. Barriers to the appropriate use of interventional techniques include inaccessibility to experienced interventionalists and absence of up-to-date knowledge among cancer care providers of the various techniques available, as well as an inadequate knowledge of which patients at what time may benefit. This manuscript will review indications, techniques, adverse effects, and costs of the most effective and safe interventional approaches to management of cancer-related pain. These include intrathecal therapies, celiac plexus neurolysis, hypogastric plexus neurolysis, vertebroplasty, kyphoplasty, and other less commonly indicated but potentially beneficial interventions. It is anticipated that a general understanding of interventional approaches to controlling cancer-related pain will lead to more appropriate and timely referral of patients for consideration of all potential therapeutic options.
