Interventional management of pain in cancer and palliative care

Pain is a common feature in people with cancer, arising from the disease and its treatment. The World Health Organization analgesic ladder promotes the use of oral opioids and adjuncts. Although most patients achieve reasonable analgesia with minimal adverse effects with oral medications, 10% continue to have severe pain and/or experience poor quality of life from drug adverse effects. These patients could benefit from appropriate interventions including peripheral nerve blocks and central neuraxial blockade, and more specialized treatment options such as neurolytic blocks, intrathecal drug delivery systems, neuromodulation and percutaneous cordotomy. These individuals should be assessed and referred in a timely manner for specialist pain management rather than holding such interventions as a last resort. Delay in referral can make it too late to deliver the quality of care that is expected by patients, their family and clinicians.