The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain

Abstract

Moderate to severe pain occurs in many cancer patients during their clinical course and may stem from the primary pathology, metastasis, or as treatment side effects. Uncontrolled pain using conservative medical therapy can often lead to patient distress, loss of productivity, shorter life expectancy, longer hospital stays, and increase in healthcare utilization. Various publications shed light on strategies for conservative medical management for cancer pain and a few international publications have reviewed limited interventional data. Our multi-institutional working group was assembled to review and highlight the body of evidence that exists for opioid utilization for cancer pain, adjunct medication such as ketamine and methadone and interventional therapies. We discuss neurolysis via injections, neuromodulation including targeted drug delivery and spinal cord stimulation, vertebral tumor ablation and augmentation, radiotherapy and surgical techniques. In the United States, there is a significant variance in the interventional treatment of cancer pain based on fellowship training. As a first of its kind, this best practices and interventional guideline will offer evidenced-based recommendations for reducing pain and suffering associated with malignancy.

A Cancer-Pain Analgesia as Prolonging Strategy of Surviving Time after Failure of Adjuvant Chemotherapy in Patient with Progressive Bone-Metastatic Hepatocellular Carcinoma

“…IT analgesic opioids reach directly first to the spinal fivers rather than systemic circulation. An application of IT analgesia for delivering opioids has several advantages: (1) efficacy of pain reduction, (2) side effect reduction, and (3) cost-effectiveness [2]. This IT analgesic relief of cancer pain could In the clinical settings, however, an effective IT analgesic strategy against severe cancerrelated pain relief seems to prolong ST in patients with bone-metastatic HCC in whom neoadjuvant therapy have been failed like this case.…”

“…IT analgesic opioids reach directly first to the spinal fivers rather than systemic circulation. An application of IT analgesia for delivering opioids has several advantages: (1) efficacy of pain reduction, (2) side effect reduction, and (3) cost-effectiveness [ 2 ]. This IT analgesic relief of cancer pain could contribute to improve QOL and prolong his ST. To confirm this hypothesis, a large accumulation of similar cases must be required to analyze.…”

“…The bone metastasis and HCC itself might cause cancer-associated pain [ 1 ]. This cancer pain is reported ranging moderate to severe in 50% of all patients with HCC associated with bone metastasis, and this pain is persistent, regardless of analgesic agents such as opioids according to cancer pain guideline [ 2 ]. An intrathecal (IT) analgesia of opioids might contribute an enhancing QOL and prolong ST in advanced cancer patients.…”

A dose‐escalation clinical trial of intranasal ketamine for uncontrolled cancer‐related pain

“…Despite high‐dose opioid use, pain may remain uncontrolled due to tolerance or unresponsive pain mechanisms 2 . In some cases, interventional procedures may be used instead 3 . However, their use may be limited by logistical (e.g., available expertise) or patient factors (e.g., abnormal lab results, reservation towards interventions, etc.)…”

“…2 In some cases, interventional procedures may be used instead. 3 However, their use may be limited by logistical (e.g., available expertise) or patient factors (e.g., abnormal lab results, reservation towards interventions, etc.). 4 Thus, identification and evaluation of new evidence-based therapies, including pharmacologic agents, to address cancer pain are imperative.…”