Interventional techniques for pain management in palliative care

Abstract 

About 10% of patients have pain that is difficult and they may benefit from interventions such as nerve blocks, intrathecal drug delivery (ITDD) or percutaneous cordotomy. Early referral for specialist pain management is needed if interventional techniques are being considered. It is important to manage pain with the simplest methods possible and to consider all available alternatives to an invasive technique. Simple nerve blocks may be easy to organise and readily accepted by the patient. More complex nerve blocks may need hospital admission and co-ordinated aftercare. ITDD is a demanding technique that requires an experienced multi-disciplinary pain team and good care in the community; this must be arranged before any intervention is considered. Cordotomy requires specialist expertise and it is probably best provided by a few centres who can maintain adequate patients numbers to retain the necessary skills.

Keywords: cancer, intrathecal drug delivery, nerve blocks, pain, palliative care