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Sympathectomy for cancer pain 

Sympathectomy for cancer pain
Chapter:
Sympathectomy for cancer pain
Author(s):

Dhanalakshmi Koyyalagunta

and Arun Bhaskar

DOI:
10.1093/med/9780199661626.003.0014
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date: 16 September 2021

Abdominal and pelvic pain from malignancies can be debilitating and often a cause for significant distress and 52–60% of patients with gastrointestinal, urogenital, and gynaecological malignancies have abdominal pain. Treatment of the pain in these patients with cancer can be challenging and often refractory to pharmacological therapy adopting the World Health Organization ladder guidelines alone. Pain physicians have adopted the use of interventional modalities to optimize pain control at various stages of the disease. Visceral innervation of the abdomen and pelvis is from the coeliac plexus, superior, and the ganglion impar. Percutaneous neurolysis of the sympathetic chain can provide significant pain relief for cancer-related visceral pain syndromes. Interruption of the sympathetic nervous system with a neurolytic agent can be achieved at the coeliac, superior, and ganglion impar. This will help optimize pain control, decrease the opioid dose and associated side effects, and result in an improvement in quality of life. The anatomy of the sympathetic axis, the various sympathetic blocks, agents commonly used, and available evidence on efficacy of these blocks are outlined in this chapter.

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