Interventional management of pain in cancer and palliative care

A significant number of cancer patients suffer from pain caused by the disease or its treatment. The World Health Organization analgesic ladder promotes the use of oral opioids and adjuncts, and reserves interventional procedures as the ‘fourth’ step in the ladder. Although this can to an extent be justified as most patients achieve reasonable analgesia with minimal adverse with oral analgesia, 10% of patients continue to have severe pain and/or experience poor quality of life from drug adverse effects. These patients could benefit from appropriate interventions including nerve blocks and central neuraxial blockade, and more specialized treatment options such as neurolytic blocks, intrathecal drug delivery systems, neuromodulation and percutaneous cordotomy. They should be assessed and referred in a timely manner for specialist pain management rather than reserving such interventions for a last resort. Delay in referral can make it too late to deliver the quality of care that is expected by both patients and clinicians.