How do nerve-destroying blocks treat cancer pain?

Cancer pain, or advanced cancer pain is one of the main causes of suffering for patients with advanced cancer. At this stage, the patient is in considerable physical and mental agony, and a significant number of patients die not directly from cancer, but from severe pain. About 80% of advanced cancer patients have severe pain, and it is estimated that at least 15 million people in the world experience pain every day. Cancer pain has been recognized as a painful disease. Most cancer pain patients have improved pain relief through the three-step treatment principle (oral analgesic drugs as the mainstay); however, some cancer pain patients still have severe pain after strict application of the “three-step drug treatment program”, or are unable to fully accept the treatment of the “three-step program” due to inability to eat, contraindications to medication, inability to tolerate the side-effects of analgesic drugs, and the excessive financial burden of taking the medication, which is known as intractable cancer pain or refractory cancer pain. Intractable cancer pain or refractory cancer pain are all indications for nerve-destructive block. Nerve-damaging blocks provide an excellent way to manage chronic cancer pain. The success of these nerve blocks depends on the patient’s understanding and cooperation, the acceptance of other departments (oncology, etc.), and the experience and skill of the pain physician, who, after proper training and operation, has improved the safety of the treatment with the precise guidance of imaging equipment (CT, C-arm). Commonly used methods are as follows: 1. Peripheral nerve disfiguring block When cancer pain is more limited and the application of medication is not effective, the use of different concentrations of phenol, ethanol, adriamycin and mitomycin solutions to block the peripheral nerves, or radiofrequency to disfigure the nerves, can often achieve satisfactory results. The role of peripheral nerve release in the treatment of pain due to malignant causes is clear and certain, although there are limitations; to ensure effective analgesia, the nerve block must be located proximal to the source of the irritation. It can be performed on an outpatient basis or in the patient’s home. It is mainly used for those with more limited pain or residual localized pain after blocking with other methods. Commonly used nerve blocks include maxillary nerve, mandibular nerve, auriculotemporal nerve, occipital nerve, suprascapular nerve, thoracic nerve, intercostal nerve, femoral nerve, obturator nerve, sciatic nerve and peroneal nerve. Subarachnoid nerve destructive block The analgesic effect and duration of subarachnoid phenol or ethanol block are better than local nerve block and nerve root block. This method is effective in controlling cancer pain but requires an experienced anesthesiologist. Phenol-glycerol block is more commonly used at present. The analgesic effect accounts for 50%~60%, 21%~30% and 18%~20%. The effect is closely related to the tumor location, the puncture gap, the injection dose and the method of pain evaluation. Most of the reported pain relief lasts from 2 weeks to 3 months, and in a few patients it lasts from 4 to 12 months. Complications after block are mainly caused by damage to non-nociceptive nerves. All treatment should be performed in the operating room. Complications of bilateral block include urinary retention, rectal dysfunction and muscle paralysis, which are mostly alleviated or disappear within one week. 3.Epidural nerve destruction block Epidural block is a method of blocking spinal nerve conduction by injecting nerve destruction drugs into the epidural cavity to produce segmental analgesia. Compared with peripheral nerve block, epidural block can block somatic and autonomic nerves at the same time, with a larger scope of block and precise effect; compared with subarachnoid block, it can avoid meningeal irritation and spinal cord or spinal nerve injury, and because the nerve-destroying drug does not directly contact the nerve root, but works outside the dura mater, so the possibility of bladder and rectal sphincter involvement is less than that of subarachnoid block, but its effect is not as good as that of subarachnoid block. However, it is not as effective as subarachnoid block. In addition, nerve destroying drugs can be injected through epidural catheter in several times. Abdominal plexus ethanol block Abdominal plexus ethanol block for the treatment of pain caused by abdominal tumors, especially pancreatic cancer pain, about 60-85% of the patients can get pain-free. It needs to be performed under X-ray fluoroscopy. Abdominal plexus blocks provide excellent relief of epigastric pain and back involvement pain caused by malignant tumors of foregut origin. It is most commonly used for pancreatic cancer, which, contrary to conventional wisdom, is most commonly characterized by pain rather than painless jaundice.NCPB is also effective for neoplastic pain in the distal esophagus, stomach, liver, bile ducts, small intestine, proximal colon, adrenal glands, and kidneys. Abdominal plexus block should be considered for pain caused by intra-abdominal malignant tumors that have been poorly treated with other methods. Abdominal plexus block has been reported to be effective for colon and rectal cancer pain as well. In conclusion, some cancer pain patients have to face dozens or hundreds of analgesics every day, but still cannot effectively relieve pain or cannot tolerate the side effects, enduring both physical and mental pain, and they are often disturbed by the inappropriate treatment methods, hoping that a miracle will happen. Nerve-destroying block provides an excellent way to control chronic cancer pain.