The role of neurolytic sympathetic blocks in treating cancer pain

Over 10 million Americans live with cancer and almost 1.5 million new cases of cancer will be diagnosed in 2009. Many of these patients will have severe pain even with optimal medical management. These patients may be offered advanced interventional procedures to manage their pain. For pain originating from the viscera, chemical neurolysis of the sympathetic nervous system may be an appropriate intervention. Common techniques employed to interrupt the sympathetic nervous system would include the celiac plexus block, the superior hypogastric plexus block, and the ganglion impar block. This article offers a discussion of the patient selection, indications, complications, and technical aspects of these pain-relieving interventions. For these patients with refractory cancer-related pain, minimally invasive, percutaneous neurolytic blocks have the potential to provide significant pain reduction and an overall improvement in their quality of life.