Interventional techniques for pain management in palliative care

Many patients with cancer suffer from pain – caused by the cancer itself, its treatment or other causes. In the majority of patients, this can be managed by analgesics and adjuncts as recommended by the World Health Organization analgesic ladder. In a significant minority of around 10%, either the pain is not controlled by drugs or the adverse effects are intolerable; interventional procedures should be considered for these patients. These range from simple nerve blocks and spinal injections to more complex techniques such as intrathecal drug delivery systems and percutaneous cordotomy. Neurolytic techniques can also be useful. Patients should be identified early and referred for specialist pain management as part of a multidisciplinary approach involving, if appropriate, the palliative medicine and oncology and surgical teams.