Interventional treatment of cancer pain

While opioids are the mainstay of cancer pain management, they have their limitations. Some patients may only tolerate moderate doses of opioids, manifesting side-effects such as sedation, confusion, and constipation. Another reason for opioid ineffectiveness may be the development of opioid-resistant pain. For these reasons, the search for analgesia may result in interventions. A wide array of procedures exists (e.g., local anesthetic/steroid deposition, neurolysis by chemical or thermic means, or the implantation of spinal pumps to deliver medications not effective by the oral/transcutaneous route) that have their own indications and side-effects profile. The pain practitioner, interventionalist or not, needs to be aware of the various options in order that an appropriate choice for comfort may be made.