Indian society for study of pain, cancer pain special interest group guidelines on interventional management for cancer pain

Abstract

The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group guidelines on interventional management for cancer pain in adults provide a structured, stepwise approach which will help to improve the management of cancer pain and to provide the patients with minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs, patient population, and situations in India. A questionnaire based on the key elements of each sub draft addressing certain inconclusive areas where evidence was lacking was made available on the ISSP website and circulated by e-mail to all the ISSP and Indian Association of Palliative Care members. We recommend using interventional management when conventional therapy fails to offer adequate benefits or causes undesirable side effects. Vertebroplasty should be offered to patients with uncontrolled bone pain when expertise is available.

Bone Cancer Pain, Mechanism and Treatment

“…The WHO analgesic ladder has proven to be very helpful, nevertheless, an estimated 12% of patients remains inadequately treated for CIBP [120]. Therefore, a fourth step has been proposed that includes interventional approaches to provide a minimal acceptable quality of life [120][121][122].…”

“…The WHO analgesic ladder has proven to be very helpful, nevertheless, an estimated 12% of patients remains inadequately treated for CIBP [120]. Therefore, a fourth step has been proposed that includes interventional approaches to provide a minimal acceptable quality of life [120][121][122]. As such, percutaneous neurolysis is performed using chemical agents or thermal energy upon celiac plexus, splanchnic nerve, superior hypogastric plexus, brachial plexus and epidural and intrathecal [120,122].…”

“…Therefore, a fourth step has been proposed that includes interventional approaches to provide a minimal acceptable quality of life [120][121][122]. As such, percutaneous neurolysis is performed using chemical agents or thermal energy upon celiac plexus, splanchnic nerve, superior hypogastric plexus, brachial plexus and epidural and intrathecal [120,122]. Commonly used neurolytic agents are absolute alcohol (diluted to 50% alcohol), 6% aqueous phenol and 6% phenol in glycerine [120].…”