Recent advances in cancer pain management

Abstract

Pain is the most feared symptom of cancer. New oncological cancer treatments are improving survival, but advanced cancer presents challenges that have not been seen before, often with pain that is very difficult to manage because of a recurrent tumour that is invading the central nervous system. In some of the older interventional techniques of destroying nerve pathways, expertise has diminished or has been deemed unnecessary with the development of specialist palliative care. Not all pain is managed adequately with the analgesic ladder. Knowledge of pain mechanisms, careful assessment and selection of the right technique at the right time will enhance cancer pain management. New techniques include intrathecal drug therapy, vertebroplasty, cordotomy, ultra-sound guided nerve blocks, neuromodulation and advances in drug therapies.

Identification of capsazepine as a novel inhibitor of system x_c^− and cancer-induced bone pain

“…These skeletal-related effects correlate to a marked increase in patient morbidity and mortality2 with cancer-induced bone pain (CIBP) affecting up to 75% of cancer patients making it a key indicator of patient quality of life 8,9. The multiplicity of nociceptive pathways contributing to CIBP makes treatment difficult and often resistant to current analgesic therapies, with over 50% of patients having persistent, unresolved pain 10. New pharmacological targets are therefore crucial to advancing therapeutic strategies that can address this clinical problem and advance patients’ quality of life.…”

Upper Antero-Medial Thigh as an Alternative Site for Implantation of Intrathecal Pumps: A Case Series

“…The infra‐clavicular fossa is another potential alternate site , however, this location carries a number of potential risks such as disruption of breast tissue in women, and damage to the adjacent brachial plexus and the vascular bundle. Moreover, compared to thigh, the infra‐clavicular fossa is a longer distance from the catheter entry site, and the location provides less space for the placement of a 40 mL pump, especially in malnourished cancer patients . IDDS can also implanted in the buttock region , however, is not opportune due to risk of pressure ulcers in the buttock and discomfort, especially for wheelchair‐bound or bedridden patients .…”

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.…”