Background & Aims
Cancer pain remains a significant challenge, with up to 80% of patients experiencing it at some point during their illness. Percutaneous neurolysis (PN) has emerged as a promising minimally invasive intervention for managing refractory oncological pain. However, the optimal selection of PN techniques is crucial for maximizing efficacy and minimizing complications. This review aims to assess the evidence supporting an individualized approach to PN technique selection in oncological pain management.
Methods
A comprehensive search was conducted across electronic databases like PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, and Scopus. We combined controlled vocabulary terms (MeSH) and keywords related to percutaneous neurolysis, oncological pain, pain management, and individualization.
Inclusion:
Studies investigating the use of PN for oncological pain management.
Studies exploring factors influencing PN technique selection, including patient characteristics, pain characteristics, and target nerve involvement.
Studies with outcomes related to pain relief, functional improvement, and safety.
Exclusion:
Studies not focused on oncological pain.
Case reports, editorials, and commentaries.
Studies without relevant outcomes data.
Two independent reviewers screened abstracts and full-text articles for eligibility. Data was extracted using a standardized extraction form, including study design, participant characteristics, intervention details & outcomes.
Results
Anatomy:
Abnormal anatomy: Congenital issues, past surgeries, or treatment-induced changes require specialized techniques like image-guided navigation or RFA to reach target nerves.
Tumor location: Target nerves depend on affected organs (e.g., Celiac Plexus for upper abdominal cancers).
Tumor proximity: Nerve proximity might necessitate alternative techniques to avoid unwanted effects.
Pain characteristics:
Pain type: Diffuse visceral pain responds well to chemical agents, while localized somatic pain may benefit from RFA.
Neuropathic pain: Understanding the origin and type (localized or diffuse) is crucial.
Disease and treatment factors:
Disease stage and prognosis: Early-stage cancers might benefit from more conservative methods, while advanced stages consider PN.For short prognoses, immediate pain relief via PN is prioritized.
Psychological aspects:
Patient concerns: Addressing anxiety about the invasive nature of PN through pre-procedure counseling is crucial.
Conclusions
An individualized approach to percutaneous neurolysis is not just beneficial; it’s essential. Each patient presents a unique constellation of factors that must be considered to ensure that the procedure is not only effective but also safe.
The interplay of disease progression, historical and concurrent treatment modalities, and the intricate tapestry of psychosocial factors significantly influence the modality, timing, and execution of percutaneous neurolysis. As oncologic care strides towards precision and individualized paradigms, the acknowledgment and adept navigation of these determinants are imperative for optimizing PN’s therapeutic potential.
References
1. Koyyalagunta D, Burton AW. The role of chemical neurolysis in cancer pain. Current pain and headache reports. 2010 Aug;14:261-7.
2. Filippiadis DK, Tselikas L, Tsitskari M, Kelekis A, de Baere T, Ryan AG. Percutaneous neurolysis for pain management in oncological patients. CardioVascular and Interventional Radiology. 2019 Jun 15;42:791-9.
3. Filippiadis DK, Yevich S, Deschamps F, Jennings JW, Tutton S, Kelekis A. The role of ablation in cancer pain relief. Current oncology reports. 2019 Dec;21:1-7.
4. Sindt JE, Brogan SE. Interventional treatments of cancer pain. Anesthesiology clinics. 2016 Jun 1;34(2):317-39.
5.Christo PJ, Mazloomdoost D. Interventional pain treatments for cancer pain. Annals of the New York Academy of Sciences. 2008 Sep;1138(1):299-328.
Presenting Author
Collin Ho
Poster Authors
Collin Ho, MBBS MMed Anesthesia
Singapore General Hospital
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care