Indian Journal of Palliative Care
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Table of Contents 
EDITORIAL
Year : 2011  |  Volume : 17  |  Issue : 2  |  Page : 91

Individualized interventional pain management technique in early stage of cancer pain: A desirable protocol for improving quality of life


Editor, IJPC Additional Professor and Head, Anesthesiology, Pain and Palliative Care, IRCH, AIIMS, New Delhi, India

Date of Web Publication5-Sep-2011

Correspondence Address:
Sushma Bhatnagar
Editor, IJPC Additional Professor and Head, Anesthesiology, Pain and Palliative Care, IRCH, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1075.84527

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How to cite this article:
Bhatnagar S. Individualized interventional pain management technique in early stage of cancer pain: A desirable protocol for improving quality of life. Indian J Palliat Care 2011;17:91

How to cite this URL:
Bhatnagar S. Individualized interventional pain management technique in early stage of cancer pain: A desirable protocol for improving quality of life. Indian J Palliat Care [serial online] 2011 [cited 2019 Oct 22];17:91. Available from: http://www.jpalliativecare.com/text.asp?2011/17/2/91/84527


Pain is an unpleasant feeling and remains to be one of the most common symptoms experienced by cancer patients around the world at some point or the other during various stages of cancer treatment. Treatment of cancer pain as per WHO ladder has seen many milestones with remarkable success in cancer pain management; however, some patients have refractory pain and require advanced techniques such as nerve blocks. Systemic drugs do relieve pain, but invariably have troublesome side effects. These side effects are often severe enough to prevent adequate therapy, and fear of them constitutes one of the most important causes of inadequate opioid prescription by physicians and its use by patients. Intervention during the early stages of pain treatment can therefore bypass these overruling side effects and increase the faith of the patient in pain physician and onset of treatment.

The mandatory facts to be understood by the treating physician for interventional pain treatment are as follows:

  • The pain should be localized.
  • The procedure should be explained to the patient and consent obtained.
  • The procedure must be patient friendly and easy, preferably bedside.
  • Physician should be well versed with the procedural technique of nerve blocks and expected outcome should be well defined.


The selective groups of patients in whom one can plan early intervention to improve the quality of life are as follows:

  • The Celiac Plexus block can be planned for pain arising from upper abdominal cancers. This block immediately relieves abdominal pain with no side effects from oral opioids taken otherwise.
  • The Superior Hypogastric Plexus block is meant for cancer pain originating from the distal colon, rectum and pelvic organs such as ovaries, bladder and prostate.
  • The Ganglion Impar block is effective for localized pain in the perineum, like in anal and vaginal cancer pain. In these patients, giving oral morphine aggravates the constipation and thereby increases suffering. By giving Ganglion Impar block, this side effect is nullified and the patient has normal defecation without pain.
  • Glossopharyngeal nerve block is effective in patients with carcinoma tongue, throat, ear and tonsils, which not only relieves baseline pain but also gives relief from troublesome pain during coughing, swallowing, chewing, speaking and laughing.
  • Mandibular and maxillary nerve block in oral cancer patients not only relieves pain, but also is very useful when the patients find difficulty in taking oral medication or are on nasogastric tube feed or with feeding jejunostomy or with percutaneous gastrostomy.


Although oral opioids are the mainstay of cancer pain management, interventional pain management techniques in certain subgroup of cancer pain patients at early stage not only give complete pain relief but also improve the quality of life and increase the faith of patients in pain physician and course of the treatment.

Further randomized trials on large group of patients are the need of the hour in order to include early intervention in the generic Cancer Pain Management Protocol.




 

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