Interventional options for the management of refractory cancer pain--what is the evidence?

Vayne-Bossert, P; Afsharimani, B; Good, P; Gray, P; Hardy, J

Interventional options for the management of refractory cancer pain--what is the evidence?

Vayne-Bossert, P Afsharimani, B Good, P

Gray, P Hardy, J

Permalink

Publisher:: SPRINGER
Publication Type:: Journal Article
Citation:: Support Care Cancer, 2016, 24, (3), pp. 1429-1438
Issue Date:: 2016-03

Closed Access

	Filename	Description	Size
	s00520-015-3047-4.pdf	Published version	355.41 kB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	Vayne-Bossert, P
dc.contributor.author	Afsharimani, B
dc.contributor.author	Good, P https://orcid.org/0000-0002-8198-0375
dc.contributor.author	Gray, P
dc.contributor.author	Hardy, J
dc.date.accessioned	2022-08-20T08:00:34Z
dc.date.available	2015-11-29
dc.date.available	2022-08-20T08:00:34Z
dc.date.issued	2016-03
dc.identifier.citation	Support Care Cancer, 2016, 24, (3), pp. 1429-1438
dc.identifier.issn	0941-4355
dc.identifier.issn	1433-7339
dc.identifier.uri	http://hdl.handle.net/10453/160566
dc.description.abstract	PURPOSE: Pain is the most common symptom in cancer patients. Standard pain treatment according to the WHO three-step analgesic ladder provides effective pain management in approximately 70-90% of cancer patients. Refractory pain is defined as not responding to "standard" treatments. Interventional analgesic techniques can be used in an attempt to control refractory pain in patients in whom conventional analgesic strategies fail to provide effective pain relief or are intolerable due to severe adverse effects. This systematic review aims to provide the latest evidence on interventional refractory pain management in cancer patients. METHODS: Systematic literature search in Cochrane, EMBASE and PubMed including reviews and randomised controlled trials (RCTs) and non-randomised controlled trials in the absence of reviews. RESULTS: Neuraxial analgesia may play a role in refractory cancer pain management. Paravertebral blocks decrease the incidence of persistent post-surgical pain after breast cancer. Coeliac plexus blocks improve pain scores in refractory pancreatic cancer pain for up to 4 weeks after the intervention with fewer burdensome side effects as compared to opioids. Cordotomy has mainly been studied in mesothelioma, and the case series suggest possible benefit for pain at the expense of a relatively high risk of side effects. CONCLUSIONS: Overall, very few RCTs have been conducted on interventional pain techniques. In reality, it is very difficult to undertake large controlled trials for a number of reasons. Therefore, today's best evidence for practice may be from large case series of comparable patients with careful response and toxicity evaluation and follow-up.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SPRINGER
dc.relation.ispartof	Support Care Cancer
dc.relation.isbasedon	10.1007/s00520-015-3047-4
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences
dc.subject.classification	Oncology & Carcinogenesis
dc.subject.mesh	Analgesics
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Pain Management
dc.subject.mesh	Pain, Intractable
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Pain, Intractable
dc.subject.mesh	Analgesics
dc.subject.mesh	Analgesics, Opioid
dc.subject.mesh	Pain Management
dc.title	Interventional options for the management of refractory cancer pain--what is the evidence?
dc.type	Journal Article
utslib.citation.volume	24
utslib.location.activity	Germany
utslib.for	11 Medical and Health Sciences
utslib.for	17 Psychology and Cognitive Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access	*
dc.date.updated	2022-08-20T08:00:33Z
pubs.issue	3
pubs.publication-status	Published
pubs.volume	24
utslib.citation.issue	3

Abstract:

PURPOSE: Pain is the most common symptom in cancer patients. Standard pain treatment according to the WHO three-step analgesic ladder provides effective pain management in approximately 70-90% of cancer patients. Refractory pain is defined as not responding to "standard" treatments. Interventional analgesic techniques can be used in an attempt to control refractory pain in patients in whom conventional analgesic strategies fail to provide effective pain relief or are intolerable due to severe adverse effects. This systematic review aims to provide the latest evidence on interventional refractory pain management in cancer patients. METHODS: Systematic literature search in Cochrane, EMBASE and PubMed including reviews and randomised controlled trials (RCTs) and non-randomised controlled trials in the absence of reviews. RESULTS: Neuraxial analgesia may play a role in refractory cancer pain management. Paravertebral blocks decrease the incidence of persistent post-surgical pain after breast cancer. Coeliac plexus blocks improve pain scores in refractory pancreatic cancer pain for up to 4 weeks after the intervention with fewer burdensome side effects as compared to opioids. Cordotomy has mainly been studied in mesothelioma, and the case series suggest possible benefit for pain at the expense of a relatively high risk of side effects. CONCLUSIONS: Overall, very few RCTs have been conducted on interventional pain techniques. In reality, it is very difficult to undertake large controlled trials for a number of reasons. Therefore, today's best evidence for practice may be from large case series of comparable patients with careful response and toxicity evaluation and follow-up.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/160566