Interventional Pain Management in Cancer Patients – Raj N. Sureja, M.D.

Cancer patients can suffer from several different types of pain, brought on by a range of causes. Often the pain can be controlled with regimented, systemic opioid therapy. According to the World Health Organization, approximately 75-95% of cancer patients experience relief with opioid therapy, in combination with adjuvant drugs, such as; anti-depressants, steroids, seizure medicines and topical drugs. This is a great level of success; however, some cancer patients continue to suffer pain. Unrelieved pain can significantly impact a person’s quality of life and take an incredible emotional toll by affecting their motivation, social connections and physical activity. These patients may benefit greatly from interventional pain management.
Cancer and the treatments prescribed for it cause patients the most pain. Causes include the following:
• Tests, such as a biopsy or spinal test
• Growing tumor pressing on tissue or organs
• Treatment, such as chemotherapy or radiation which can cause neuropathic pain
• Back pain, often caused by spinal cord compression when a tumor spreads and puts pressure on the spine
It is very important that the patient’s healthcare team work together on a plan to control pain. Communication is key – the patient is the only one who knows what he or she is feeling, so talking about it is the best way to get results. The World Health Organization has developed guidelines for treating cancer with non-opioid pain medications, opioids, adjuvant medications, and interventional care. These guidelines provide practitioners with recommended steps to follow.
For some intractable pain not relieved by conventional medication therapy, there are a variety of non-surgical procedures and treatments that an Interventional Pain Management Specialist can introduce as part of the pain control plan. These include the following:
• Spinal Cord Stimulation (SCS) – SCS uses a thin cable, or lead, to deliver low-level electrical impulses to the spinal cord. These impulses interfere with the signaling of pain between the spinal cord and the brain. The lead is placed into the epidural space around the spinal cord and is then attached to a generator, which is controlled with a hand-held programmer. With SCS, we can treat injury to nerves in arms and legs due to tumor, pain from poor circulation or peripheral neuropathy,
• Steroid Injections to care for intractable pain from cancer that has spread
• Epidural Injections for low back and neck pain
There are special factors to consider when selecting patients for interventional pain management procedures or treatments. Cancer patients are medically complex and often suffer from additional conditions as a result of their cancer diagnosis. Because of this, we at OSC prefer that the patients’ oncologist works with them on the medication aspect of pain management. We will provide some treatments and procedures that an oncologist cannot. When doing so, we take extra special care to thoroughly examine and evaluate the patient prior to any interventional treatment, as there are many clinical scenarios to consider. If you are interested in a particular procedure, we encourage you to speak with your oncologist, who can refer to you OSC’s Interventional Pain Management team if he or she feels interventional pain management would be beneficial to you.
Raj N. Sureja, MD, is a Fellowship-trained, Board-certified, Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. For more information about Dr. Sureja and his practice, go to www.osc-ortho.com. For an appointment, call 757-596-1900.