Interventional Analgesic Management of Lung Cancer Pain

Abstract

Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases.

Emergencies in Lung Cancer

“…Tedavi görenlerde yaklaşık %50 oranında iken, ileri evre hastalarda ise bu oran %90'lara varmaktadır. Tümörün göğüs duvarına lokal invazyonu, kemik metastazı, brakial pleksus tutlumu, diğer sinir tutulumları, pankoast tümörü gibi nedenlere bağlı olarak ağrı oluşmaktadır (42) . Tedavi edilmeyen ağrı aynı zamanda kişinin fiziksel ve psikolojik durmunu da etkileyerek hayat kalitesinde bozulmaya yol açar (42,43) .…”

“…Tümör ile aynı tarafta donuk, acıtıcı, kalıcı, kötü lokalize edilebilen bir ağrıdır. Eğer tümör göğüs duvarı ve kostaları tutmuş ise kısmen daha iyi lokalize edilebilir (42) . Küçük hücreli dışı akciğer kanserli olguların büyük bir çoğunluğu göğüs ağrısından yakınmaktadır.…”

“…Göğüs ağrısının diğer nedenleri plevral metastaz sonucu kemik inflamasyonuna bağlı ağrı, kostaların metastatik tutulumuna bağlı ağrı yada litik metas-tazlar sonucu gelişen kırıklara bağlı ağrılar, interkostal sinir hasarına bağlı nöropatik ağrılardır. Bu ağrılar hasta hareketlerini de kısıtlar (42,43) .…”

“…Özellikle süperior sulkus tümörlerinde brakial pleksus tutulumu nedeniyle göğüs ve omuzda şiddetli ağrılar görülebilmektedir (42) .…”

Modeling cancer pain: “the times they are a-changin’”

“…Understanding cancer pain through this approach is a major key to provide an optimal management for our patients with cancer pain. Rather than a step-wise approach, this exhaustive pain medicine leads to multimodal and personalized responses, by associating interventional and integrated complementary approaches to current therapeutics strategies [4][5][6][7][8][9], and beyond, opening the way to supportive medicine in a simple, integrative, dynamic patients' management model. Integrating supportive medicine to cancer and serious chronic diseases pathway can be a key operational response, in parallel to the constant hyperspecialization of medicine.…”