Invasive treatment of cancer pain

Cancer pain, or advanced cancer pain, is one of the main causes of suffering for patients with advanced cancer. During this stage, patients are in considerable physical and mental pain, 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. However, some cancer patients still have severe pain after strict application of the “three-step drug treatment plan”, or they are unable to accept the treatment of the “three-step plan” because they cannot eat, have contraindications to drugs, or cannot tolerate the side effects of analgesic drugs, or the economic burden of taking drugs is too great, which are called intractable cancer pain or refractory cancer pain. or refractory cancer pain, are all indications for invasive treatment. Peripheral nerve block and minimally invasive interventional radiofrequency treatment When cancer pain is limited and the effect of opioid treatment is not good, using different concentrations of local anesthetic drugs to block peripheral nerves or using radiofrequency to destroy nerves can often achieve satisfactory results. It is mainly used for limbs with more limited pain sites. Such as the head and face, extremities, superficial thoracic and abdominal areas. Commonly used nerve blocks include maxillary nerve, mandibular nerve, auriculotemporal nerve, greater occipital nerve, suprascapular nerve, thoracic nerve, intercostal nerve, femoral nerve, closed foraminal nerve, sciatic nerve and peroneal nerve. 2.Epidural nerve destructive block Epidural block is a method of injecting nerve destructive drugs into the epidural cavity to block spinal nerve conduction and produce segmental analgesia. Compared with peripheral nerve block, epidural block can block both somatic and autonomic nerves, and the blocking range is larger and more effective. Because the nerve-destroying drug does not directly contact the spinal cord and cauda equina, it works outside the dura, so the possibility of bladder and rectal sphincter involvement is less than that of subarachnoid block. In addition, the epidural catheter can be used to inject nerve-destroying drugs in several times. 3.Chemical destruction of the abdominal plexus Ethanol block of the abdominal plexus for the treatment of pain caused by abdominal tumors, especially pancreatic cancer pain, about 60-85% of patients can obtain pain-free. The abdominal plexus drug destruction can well relieve the epigastric pain and back involvement pain caused by primary and secondary tumors in the abdominal cavity. It is most commonly used for pancreatic cancer, which, contrary to conventional wisdom, is most commonly associated with pain rather than painless jaundice. It is also effective for neoplastic pain in the distal esophagus, stomach, liver, bile duct, small intestine, proximal colon, adrenal glands and kidney. Pain due to intra-abdominal malignancies that are not well treated with other methods should be considered for abdominal plexus block. It has been reported that abdominal plexus block is also effective for pain of colon and rectal cancer. 4.Spinal cord electrical stimulation technique Spinal cord electrical stimulation technique is a new technique developed in the past 20 years, which replaces the painful sensation of lesion with the tingling sensation and has the outstanding advantages of not damaging nerves, completely reversible treatment process and not affecting the motor function of limbs. It can be called the green therapy in invasive treatment of cancer pain. In the United States, nearly 200,000 patients receive such treatment every year and obtain satisfactory pain relief. This technique can be considered for limb and trunk pain; especially for cancer neuropathic pain that is not well controlled by opioids, it can achieve satisfactory results. 5.Central target-controlled analgesic infusion system The outstanding advantage of this treatment method is that it can achieve the same pain relief effect with one third of the oral dose or one hundredth of the intravenous dose, which greatly reduces the side effects associated with oral or intravenous administration. The system is surgically implanted under local anesthesia, with a catheter placed in the subarachnoid space at one end and connected to a microcomputer-controlled programmable morphine pump at the other. It achieves a single infusion of morphine to support six months of medication. Unlike spinal cord electrical stimulation, it can control pain in multiple areas of the body and has the advantage of personalized drug administration according to the patient’s different time periods and pain levels, which is the most advanced method for the treatment of intractable cancer pain at present. In a word, some cancer pain patients have to face tens or hundreds of analgesics every day, but still cannot effectively relieve pain or tolerate the side effects, enduring both physical and mental pain, and they are often troubled by the unsuitability of treatment methods, hoping for a miracle. The above treatment methods provide a better way to control some of the persistent cancer pain.