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Cancer pain procedures

Where cancer pain is not adequately controlled by medication, or where medication side effects are limiting, targeted procedures can reduce pain directly. These include nerve blocks, neurolytic techniques and intrathecal catheters, and they are used alongside — not instead of — your existing care.

Most cancer pain can be managed with medication. Where it cannot, or where the doses required cause sedation, nausea or confusion that costs someone the time they have, targeted procedures can reduce pain at its source and allow medication to be reduced.

Nerve and plexus blocks. Local anaesthetic placed around a nerve or nerve plexus supplying the painful region interrupts pain transmission. This is often used first as a diagnostic and predictive step — establishing how much pain is carried by that target before anything longer-lasting is done.

Neurolytic techniques. Where the situation warrants a longer-lasting result, the nerve can be interrupted more durably. Coeliac plexus and other visceral targets are well established for pain from abdominal malignancy, and can substantially reduce both pain and the medication burden. These are considered carefully, with the expected duration of benefit weighed against the clinical situation.

Intrathecal catheters. Delivering medication directly into the fluid around the spinal cord achieves effect at a small fraction of the systemic dose, which markedly reduces side effects. This is used in selected patients with severe pain not controlled by other means, and is set up in coordination with the treating and palliative care teams.

Timing. These options are often considered late, when they would have helped earlier. Referral at the point where pain is becoming difficult to control — rather than when all else has failed — allows better planning and a better result.

Working with your team. Dr Martin works alongside your oncologist, palliative care physician and general practitioner. Nothing is done in isolation, and the aim is to fit with the overall direction of your care and your own priorities.

Referral. Referrals for cancer pain are prioritised. GPs, oncologists and palliative care teams can contact the rooms directly to discuss timing.

Risks. Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.