Treatment Considerations for Cancer Pain Syndromes

  • Devin Peck
  • Gendai J. EchezonaEmail author


When considering interventional therapeutic options for management of pain in the patient with cancer, active or in remission, thought must be given to the possibility of elevated risk about infection and bleeding complications. Concomitant therapy with anticoagulants or chemotherapeutic agents coupled with frequently frail physiology can elevate risk. When treating pain in those with cancer or a history of cancer – even in patients without active disease – close review of each patient’s laboratory data and medication list is always advisable.


Cancer pain Anticoagulation Interventional pain management Nerve blocks Spinal cord stimulation Kyphoplasty Postmastectomy pain Post-thoracotomy pain 


  1. 1.
    Deer TR, et al. Comprehensive consensus based guidelines on intrathecal drug delivery systems in the treatment of pain caused by cancer pain. Pain Physician. 2011;14:E283–312.PubMedGoogle Scholar
  2. 2.
    Lin Y, Foltz LM. Proposed guidelines for platelet transfusion Issue. BCMJ. 2005;47(5):245–8.Google Scholar
  3. 3.
    Boehm S, Rothermundt C, Hess D, Joerger M. Antiangiogenic drugs in oncology: a focus on drug safety and the elderly – a mini-review. Gerontology. 2010;56:303–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Streiff MB. Diagnosis and initial treatment of venous thromboembolism in patients with cancer. J Clin Oncol. 2009;27:4889–94.PubMedCrossRefGoogle Scholar
  5. 5.
    Terese T, Horlocker MD, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy-American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43(2):263–309.Google Scholar
  6. 6.
    Malik B, Stillman M. Chemotherapy-induced peripheral neuropathy. Curr Neurol Neurosci Rep. 2008;8(1):56–65.PubMedCrossRefGoogle Scholar
  7. 7.
    Quasthoff S, Hartung HP. Chemotherapy-induced peripheral neuropathy. J Neurol. 2002;249(1):9–17.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Chaudhry V, Eisenberger MA, Sinibaldi VJ, Sheikh K, Griffin JW, Cornblath DR. A prospective study of suramin-induced peripheral neuropathy. Brain. 1996;119(Pt 6):2039–52.PubMedCrossRefGoogle Scholar
  9. 9.
    Loh J, Gulati A. The use of transcutaneous electrical nerve stimulation (TENS) in a major cancer center for the treatment of severe cancer-related pain and associated disability. Pain Med. 2013;16(6):1204–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Cata JP, Cordella JV, Burton AW, Hassenbusch SJ, Weng HR, Dougherty PM. Spinal cord stimulation relieves chemotherapy-induced pain: a clinical case report. J Pain Symptom Manag. 2004;27(1):72–8.CrossRefGoogle Scholar
  11. 11.
    Medtronic, Inc. MRI guidelines for Medtronic neurostimulation systems for chronic pain. Minneapolis: Medtronic, Inc; 2013.Google Scholar
  12. 12.
    Dellon AL, Swier P, Maloney CT Jr, Livengood MS, Werter S. Chemotherapy-induced neuropathy: treatment by decompression of peripheral nerves. Plast Reconstr Surg. 2004;114(2):478–83.PubMedCrossRefGoogle Scholar
  13. 13.
    Vera Llonch M, Oster G, Hagiwara M, Sonis S. Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma. Cancer. 2006;106(2):329–36.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosenthal DI, Trotti A. Strategies for managing radiation-induced mucositis in head and neck cancer. In: Seminars in radiation oncology (Vol. 19, No. 1, pp. 29–34). WB Saunders; 2009.Google Scholar
  15. 15.
    Ruggiero S, Gralow J, Marx RE, Hoff AO, Schubert MM, Huryn JM, et al. Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. J Oncol Pract. 2006;2(1):7–14.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Jereczek-Fossa BA, Orecchia R. Radiotherapy-induced mandibular bone complications. Cancer Treat Rev. 2002;28(1):65–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Erdine S, Racz G, Noe C. Somatic blocks of the head and neck. In: Raj P, et al., editors. Interventional pain management, image-guided procedures. Philadelphia: Saunders; 2008.Google Scholar
  18. 18.
    Candido K, Batra M. Nerve blocks of the head and neck. In: Benzon H, et al., editors. Raj’s practical management of pain. Philadelphia: Mosby; 2008.Google Scholar
  19. 19.
    Stubblefield MD. Radiation fibrosis syndrome: neuromuscular and musculoskeletal complications in cancer survivors. PM&R. 2011;3(11):1041–54.CrossRefGoogle Scholar
  20. 20.
    Dolly JO, Aoki KR. The structure and mode of action of different botulinum toxins. Eur J Neurol. 2006;12(Suppl 4):1–9.CrossRefGoogle Scholar
  21. 21.
    Stubblefield MD, Levine A, Custodio CM, Fitzpatrick T. The role of botulinum toxin type A in the radiation fibrosis syndrome: a preliminary report. Arch Phys Med Rehabil. 2008;89(3):417–21.PubMedCrossRefGoogle Scholar
  22. 22.
    Sarin A, Safar B. Management of radiation proctitis. Gastroenterol Clin N Am. 2013;42(4):913–25.CrossRefGoogle Scholar
  23. 23.
    Kurdali B, Sterban S, Siefferman J. Spinal cord stimulator lead placement via sacral hiatus in the treatment of post radiation proctitis. 16th annual North American neuromodulation society. From innovation to reality. 2012.Google Scholar
  24. 24.
    Krames E. Spinal cord stimulation: indications, mechanism of action, and efficacy. Curr Rev Pain. 1999;3(6):419–26.PubMedCrossRefGoogle Scholar
  25. 25.
    Hunter C, Dave N, Diwan S, Deer T. Neuromodulation of pelvic visceral pain: review of the literature and case series of potential novel targets for treatment. Pain Pract. 2013;13(1):3–17.PubMedCrossRefGoogle Scholar
  26. 26.
    Delanian S, Lefaix JL, Pradat PF. Radiation-induced neuropathy in cancer survivors. Radiother Oncol. 2012;105(3):273–82.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Delanian S, et al. Radiation-induced neuropathy in cancer survivors. Radiother Oncol. 2012;105:273–82.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Pfeilschifter J, Diel IJ. Osteoporosis due to cancer treatment: pathogenesis and management. J Clin Oncol. 2000;18(7):1570–93.PubMedCrossRefGoogle Scholar
  29. 29.
    Lustberg MB, Reinbolt RE, Shapiro CL. Bone health in adult cancer survivorship. J Clin Oncol. 2012;30(30):3665–74. Epub 2012 Sep 24PubMedCrossRefGoogle Scholar
  30. 30.
    Schiff D, Jensen ME. Kyphoplasty in cancer: an encouraging step. Lancet Oncol. 2011;12(3):202–3. Scholar
  31. 31.
    Burton AW, Mendel E. Vertebroplasty and kyphoplasty. Pain Physician. 2003;6:335–43. IPubMedGoogle Scholar
  32. 32.
    Hoh BL, Rabinov JD, Pryor JC, Hirsch JA. Balloon kyphoplasty for vertebral compression fracture using a unilateral balloon tamp via a uni-pedicular approach: technical note. Pain Physician. 2004;7:111–4.PubMedGoogle Scholar
  33. 33.
    Melvin Hu M, Eskey CJ, Tong SC, Nogueira RG, Pomerantz SR, Rabinov JD, Pryor JC, Hirsch JA. Kyphoplasty for vertebral compression fracture via a uni-pedicular approach. Pain Physician. 2005;8:363–7.PubMedGoogle Scholar
  34. 34.
    Cho CH, Mathis JM, Ortiz O. Sacral fractures and sacroplasty. Neuroimaging Clin N Am. 2010;20:179–86.PubMedCrossRefGoogle Scholar
  35. 35.
    Shah RV. Sacral kyphoplasty for the treatment of painful sacral insufficiency fractures and metastases. Spine J. 2012;12(2):113–20.PubMedCrossRefGoogle Scholar
  36. 36.
    Burton AW, Fanciullo GJ, Beasley RD, Fisch MJ. Chronic pain in the cancer survivor: a new frontier. Pain Med. 2007;8(2):189–98.PubMedCrossRefGoogle Scholar
  37. 37.
    Stubblefield MD, Keole N. Upper body pain and functional disorders in patients with breast cancer. PM&R. 2013;6:170–83.CrossRefGoogle Scholar
  38. 38.
    Rajput K. Painful neuromas. Clin J Pain. 2012;28(7):639–45.PubMedCrossRefGoogle Scholar
  39. 39.
    Friedman T, Adler R. Sonographically guided cryoneurolysis: preliminary experience and clinical outcomes. Ultrasound Med. 2012;31(12):2025–34.CrossRefGoogle Scholar
  40. 40.
    Rathmell JP. Atlas of image-guided intervention in regional anesthesia and pain medicine. Philadelphia: Lippincott Williams & Wilkins; 2011.Google Scholar
  41. 41.
    Hardy PA. Anatomical variation in the position of the proximal intercostal nerve. Br J Anaesth. 1988;61:338–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Byas-Smith MG, Gulati A. Ultrasound-guided intercostal nerve cryoablation. Anesth Analg. 2006;103(4):1033–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Karmakar MK. Ultrasound-guided thoracic paravertebral block. In: Atlas of ultrasound-guided procedures in interventional pain management. New York: Springer; 2011. p. 133–48.CrossRefGoogle Scholar
  44. 44.
    Freynet A, Falcoz PE. Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy? Interact Cardiovasc Thorac Surg. 2010;10(2):283–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Tremont-Lukats IW, Teixeira GM, Backonja MM. Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database of Systematic Reviews. 2005Google Scholar
  46. 46.
    Fishman SM. Bonica’s management of pain. Philadelphia: Lippincott Williams & Wilkins; 2012.Google Scholar
  47. 47.
    Visser E, Schug SA. The role of ketamine in pain management. Biomed Pharmacother. 2006;60(7):341–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Graybill J, Conermann T, Kabazie AJ, Chandy S. Spinal cord stimulation for treatment of pain in a patient with post thoracotomy pain syndrome. Pain Physician. 2011;14:441–5.PubMedGoogle Scholar
  49. 49.
    Wininger KL, Bester ML, Deshpande KK. Spinal cord stimulation to treat postthoracotomy neuralgia: non–small-cell lung cancer: a case report. Pain Manag Nurs. 2012;13(1):52–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Borsje S, Bosmans JC, Vander Schans CP, Geertzen JHB, Dijkstra PU. Phantom pain: a sensitivity analysis. Disabil Rehabil. 2004;26(14–15):905–10.PubMedCrossRefGoogle Scholar
  51. 51.
    Cohen SP, Gambel JM, Raja SN, Galvagno S. The contribution of sympathetic mechanisms to postamputation phantom and residual limb pain: a pilot study. J Pain. 2011;12(8):859–67.PubMedCrossRefGoogle Scholar
  52. 52.
    Ilfeld BM, Moeller-Bertram T, Hanling SR, Tokarz K, Mariano ER, Loland VJ, Wallace MS. Treating intractable phantom limb pain with ambulatory continuous peripheral nerve blocks: a pilot study. Pain Med. 2013;14(6):935–42.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Kern U, Martin C, Scheicher S, Müller H. Botulinum toxin type A influences stump pain after limb amputations. J Pain Symptom Manag. 2003;26(6):1069–70.CrossRefGoogle Scholar
  54. 54.
    Wu H, Sultana R, Taylor KB, Szabo A. A prospective randomized double-blinded pilot study to examine the effect of botulinum toxin type A injection versus lidocaine/depomedrol injection on residual and phantom limb pain: initial report. Clin J Pain. 2012;28(2):108.PubMedCrossRefGoogle Scholar
  55. 55.
    Nielson KD, Adams JE, Hosobuchi Y. Phantom limb pain: treatment with dorsal column stimulation. J Neurosurg. 1975;42:301–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Viswanathan A, Phan PC, Burton AW. Use of spinal cord stimulation in the treatment of phantom limb pain: case series and review of the literature. Pain Pract. 2010;10(5):479–84.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Austin Interventional PainAustinUSA
  2. 2.Eagle Consulting ServicesWhite PlainsUSA

Personalised recommendations