- Section 1 The worldwide status of palliative care
- Section 2 The challenge of palliative medicine
- Section 3 Service delivery issues in palliative care
- Section 4 The interdisciplinary team
- Section 5 Ethical issues
- Section 6 Communication and palliative medicine
- Section 7 Assessment tools and Informatics
- Section 8 Common symptoms and disorders
- Section 9 Common symptoms and disorders: pain
- 9.1 Principles of drug therapy: focus on opioids
- 9.2 Pathophysiology of pain in cancer and other terminal illnesses
- 9.3 Definition and assessment of chronic pain in advanced disease
- 9.4 Opioid therapy: optimizing analgesic outcomes
- 9.5 Opioid therapy: managing risks of abuse, addiction, and diversion
- 9.6 Non-opioid analgesics
- 9.7 Adjuvant analgesics
- 9.8 Interventional approaches for chronic pain
- 9.9 Neurostimulation in pain management
- 9.10 Rehabilitation medicine approaches to pain management
- 9.11 Psychological and psychiatric interventions in pain control
- 9.12 Complementary therapies in pain management
- 9.13 Paediatric pain control
- Section 10 Common symptoms and disorders: gastrointestinal symptoms
- Section 11 Common symptoms and disorders: skin problems
- Section 12 Issues in populations with cancer
- Section 13 Cancer pain syndromes
- Section 14 Cancer-associated disorders
- Section 15 Issues in populations with non-cancer illnesses
- Section 16 Issues of the very young and the very old
- Section 17 Psychosocial and spiritual issues in palliative medicine
- Section 18 The terminal phase
- Section 19 Research in palliative medicine
(p. 589) Interventional approaches for chronic pain
- Chapter:
- (p. 589) Interventional approaches for chronic pain
- Author(s):
Robert A. Swarm
, Menelaos Karanikolas
, Lesley K. Rao
, and Michael J. Cousins
- DOI:
- 10.1093/med/9780199656097.003.0098
Severe, uncontrolled pain remains common in populations with serious or life-threatening illness. Despite the availability of oral opioid therapy in most developed countries, an estimated 10-30% of people with advanced cancer have inadequate pain control. Published guidelines endorse the view that these patients should be considered for procedural, or so-called interventional, pain therapies. Generally accepted indications for interventional pain therapies include (a) uncontrolled pain despite systemic analgesics and (b) unacceptable systemic analgesic adverse effects. This chapter describes these therapies and discusses how they are best used within a multimodal strategy for symptom management. Interventional pain therapies are now incorporated into best practices for cancer pain management. These therapies, especially spinal analgesics, neurolytic coeliac plexus block, and vertebroplasty, have become essential components of palliative care, to control pain that cannot be safely and effectively managed with systemic analgesics.
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- Section 1 The worldwide status of palliative care
- Section 2 The challenge of palliative medicine
- Section 3 Service delivery issues in palliative care
- Section 4 The interdisciplinary team
- Section 5 Ethical issues
- Section 6 Communication and palliative medicine
- Section 7 Assessment tools and Informatics
- Section 8 Common symptoms and disorders
- Section 9 Common symptoms and disorders: pain
- 9.1 Principles of drug therapy: focus on opioids
- 9.2 Pathophysiology of pain in cancer and other terminal illnesses
- 9.3 Definition and assessment of chronic pain in advanced disease
- 9.4 Opioid therapy: optimizing analgesic outcomes
- 9.5 Opioid therapy: managing risks of abuse, addiction, and diversion
- 9.6 Non-opioid analgesics
- 9.7 Adjuvant analgesics
- 9.8 Interventional approaches for chronic pain
- 9.9 Neurostimulation in pain management
- 9.10 Rehabilitation medicine approaches to pain management
- 9.11 Psychological and psychiatric interventions in pain control
- 9.12 Complementary therapies in pain management
- 9.13 Paediatric pain control
- Section 10 Common symptoms and disorders: gastrointestinal symptoms
- Section 11 Common symptoms and disorders: skin problems
- Section 12 Issues in populations with cancer
- Section 13 Cancer pain syndromes
- Section 14 Cancer-associated disorders
- Section 15 Issues in populations with non-cancer illnesses
- Section 16 Issues of the very young and the very old
- Section 17 Psychosocial and spiritual issues in palliative medicine
- Section 18 The terminal phase
- Section 19 Research in palliative medicine