Head and Neck Cancer Pain

  • Vinay PuttanniahEmail author
  • Elena V. Zininberg


Cancers of the head and neck are a small percentage of malignancies but can be associated with significant pain and deformity. Tumors may present with nociceptive (somatic), neuropathic, or mixed pain symptoms. In addition, treatments including chemotherapy, radiation, and surgery can cause specific pain syndromes. Treatments for head and neck cancer include medical treatments, but interventional pain options have been successfully performed for patients suffering from these pain syndromes. This chapter seeks to outline the various interventional options for patients suffering from pain from head and neck cancer.


Head and neck cancer pain Nociceptive pain Postsurgical pain syndromes Radiation-induced pain syndromes Interventional cancer pain 


  1. 1.
    Chaplin JM, Morton RP. Prospective, longitudinal study of pain in head and neck cancer patients. Head Neck. 1999;21(6):531–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20(8):1420–33.PubMedCrossRefGoogle Scholar
  3. 3.
    Davies L, Welch HG. Epidemiology of head and neck cancer in the United States. Otolaryngol Head Neck Surg. 2006;135(3):451–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Sanderson RJ, Ironside JA. Squamous cell carcinomas of the head and neck. BMJ. 2002;325(7368):822–7.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Caraceni A, Portenoy RK. An international survey of cancer pain characteristics and syndromes. IASP task force on cancer pain. International association for the study of pain. Pain. 1999;82(3):263–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Vecht CJ, Hoff AM, Kansen PJ, et al. Types and causes of pain in cancer of the head and neck. Cancer. 1992;70(1):178–84.PubMedCrossRefGoogle Scholar
  7. 7.
    Trotter PB, et al. Pharmacological and other interventions for head and neck cancer pain: a systematic review. J Oral Maxillofac Res. 2012;3(4):e1.CrossRefGoogle Scholar
  8. 8.
    Binczak M, et al. Management of somatic pain induced by head-and-neck cancer treatment: definition and assessment guidelines of the French Oto-Rhino-Laryngology- Head and Neck Surgery Society. Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131(4):243–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Villaret D, Weymuller E. Pain caused by cancer of the head and neck. In: Loeser J, Butler S, Chapman R, editors. Bonica’s management of pain. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 948–65.Google Scholar
  10. 10.
    Foley KM. The treatment of cancer pain. N Engl J Med. 1985;313:84–95.PubMedCrossRefGoogle Scholar
  11. 11.
    Roodman GD. Mechanisms of bone metastasis. N Engl J Med. 2004;350:1655–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Caldemeyer KS, Mathews VP, Righi PD, Smith RR. Imaging features and clinical significance of perineural spread or extension of head and neck tumours. Radiographics. 1998;18(1):97–110.PubMedCrossRefGoogle Scholar
  13. 13.
    Mehio AK, Shah SK. Alleviating head and neck pain. Otolaryngol Clin N Am. 2009;42(1):143–59.CrossRefGoogle Scholar
  14. 14.
    Alentorn A, et al. Presenting signs and symptoms in brain tumors. Handb Clin Neurol. 2016;134:19–26.PubMedCrossRefGoogle Scholar
  15. 15.
    Mirabile A, et al. Pain management in head and neck cancer patients undergoing chemo-radiotherapy: clinical practical recommendations. Crit Rev Oncol Hematol. 2016;99:100–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Riley P, Glenny AM, Worthington HV, Littlewood A, Clarkson JE, McCabe MG. Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy. Cochrane Database Syst Rev. 2015;(12). Art. No.: CD011552.Google Scholar
  17. 17.
    Pandya JA, et al. Post-radiation changes in oral tissues – an analysis of cancer irradiation cases. South Asian J Cancer. 2014;3(3):159–62.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Henriques de Figueiredo B, Grégoire V. How to minimize morbidity in radiotherapy of pharyngolaryngeal tumors? Curr Opin Otolaryngol Head Neck Surg. 2016;24(2):163–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Straub JM, et al. Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol. 2015;141(11):1985–94.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Chan JY, et al. Shoulder dysfunction after selective neck dissection in recurrent nasopharyngeal carcinoma. Otolaryngol Head Neck Surg. 2015;153(3):379–84.PubMedCrossRefGoogle Scholar
  21. 21.
    Lauchlan DT, McCaul JA, McCarron T. Neck dissection and the clinical appearance of post-operative shoulder disability: the post-operative role of physiotherapy. Eur J Cancer Care. 2008;17(6):542–8. [PubMed].Google Scholar
  22. 22.
    Rogers SN, Ferlito A, Pellitteri PK, Shaha AR, Rinaldo A. Quality of life following neck dissections. Acta Otolaryngol. 2004;124(3):231–6. [PubMed].PubMedCrossRefGoogle Scholar
  23. 23.
    Terrell JE, et al. Pain, quality of life, and spinal accessory nerve status after neck dissection. Laryngoscope. 2000;110(4):620–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Epstein JB, Wilkie DJ, Fischer DJ, Kim Y-O, Villines D. Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy. Head Neck Oncol. 2009;1:26.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Grond S, et al. Validation of World Health Organization guidelines for pain relief in head and neck cancer. A prospective study. Ann Otol Rhinol Laryngol. 1993;102(5):342–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Coderre TJ, et al. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52(3):259–85.PubMedCrossRefGoogle Scholar
  27. 27.
    Connolly I, et al. Management of severe neuropathic cancer pain: an illustrative case and review. Am J Hosp Palliat Care. 2013;30(1):83–90.PubMedCrossRefGoogle Scholar
  28. 28.
    Mastsumoto S. Thermographic assessment of the sympathetic blockade by stellate ganglion block (20); Comparison between C7-SGB and C6-SGB in 20 healthy volunteers. Masui. 1991;40:692–701.Google Scholar
  29. 29.
    Prasanna A, Murthy PS. Sphenopalatine ganglion block and pain of cancer. J Pain Symptom Manag. 1993;8(3):125.CrossRefGoogle Scholar
  30. 30.
    Levin M. Nerve blocks in the treatment of headache. Neurotherapeutics. 2010;7(2):197–203.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Dach F, et al. Nerve block for the treatment of headaches and cranial neuralgias – a practical approach. Headache. 2015;55(Suppl 1):59–71.PubMedCrossRefGoogle Scholar
  32. 32.
    Kohase H, Umino M, Shibaji T, et al. Application of a mandibular nerve block using an indwelling catheter for intractable cancer pain. Acta Anaesthesiol Scand. 2004;48(3):382–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Klessinger S. The benefit of therapeutic medial branch blocks after cervical operations. Pain Physician. 2010;13(6):527–34.PubMedGoogle Scholar
  34. 34.
    Sist T, Miner M, Lema M. Characteristics of postradical neck pain syndrome: a report of 25 cases. J Pain Symptom Manage. 1999;18(2):95–102.PubMedCrossRefGoogle Scholar
  35. 35.
    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
  36. 36.
    DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain. Curr Rheumatol Rep. 2008;10(6):492–9.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    DeSantana JM, Santana-Filho VJ, Guerra DR, et al. Hypoalgesic effect of the transcutaneous electrical nerve stimulation following inguinal herniorrhaphy: a randomized, controlled trial. J Pain. 2008;9:623–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Solak O, Turna A, Pekcolaklar A, et al. Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study. Thorac Cardiovasc Surg. 2007;55:182–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Vijayan A, et al. Prospective phase II study of the efficacy of transcutaneous electrical nerve stimulation in post-radiation patients. Clin Oncol (R Coll Radiol). 2014;26(12):743–7.CrossRefGoogle Scholar
  40. 40.
    Lakshman AR, et al. Evaluation of effect of transcutaneous electrical nerve stimulation on salivary flow rate in radiation induced xerostomia patients: a pilot study. J Cancer Res Ther. 2015;11(1):229–33.PubMedCrossRefGoogle Scholar
  41. 41.
    Yakovlev AE, et al. Treatment of cancer-related chest wall pain using spinal cord stimulation. Am J Hosp Palliat Care. 2010;27(8):552–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Maniam R, Kaye AD, Vadivelu N, Urman RD. Facial pain update: advances in neurostimulation for the treatment of facial pain. Curr Pain Headache Rep. 2016;20(4):24.PubMedCrossRefGoogle Scholar
  43. 43.
    Smith TJ, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20(19):4040–9.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Appelgren L, Janson M, Nitescu P, Curelaru I. Continuous intracisternal and high cervical intrathecal bupivacaine analgesia in refractory head and neck pain. Anesthesiology. 1996;84(2):256–72.PubMedCrossRefGoogle Scholar
  45. 45.
    Lundborg C, et al. High intrathecal bupivacaine for severe pain in the head and neck. Acta Anaesthesiol Scand. 2009;53(7):908–13.PubMedCrossRefGoogle Scholar
  46. 46.
    Datta S, Pai UT. Interventional approaches to management of pain of oral cancer. Oral Maxillofac Surg Clin North Am. 2006;18(4):627–41.PubMedCrossRefGoogle Scholar
  47. 47.
    Lazorthes YR, Sallerin BA, Verdié JC. Intracerebroventricular administration of morphine for control of irreducible cancer pain. Neurosurgery. 1995;37(3):422–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Onofrio BM. Radiofrequency percutaneous Gasserian ganglion lesions. Results in 140 patients with trigeminal pain. J Neurosurg. 1975;42(2):132–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Dubuisson D. Treatment of occipital neuralgia by partial posterior rhizotomy at C1–3. J Neurosurg. 1995;82(4):581–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Choi I, Jeon SR. Neuralgias of the head: occipital neuralgia. J Korean Med Sci. 2016;31(4):479–88.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Gande AV, et al. Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia. J Neurosurg. 2015;18:1–9.Google Scholar
  52. 52.
    McDonald GJ, et al. Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain. Neurosurgery. 1999;45(1):61–7.PubMedGoogle Scholar
  53. 53.
    Blume HG. Cervicogenic headaches: radiofrequency neurotomy and the cervical disc and fusion. Clin Exp Rheumatol. 2000;18(2):S53–8.PubMedGoogle Scholar
  54. 54.
    Lee JB, et al. Clinical efficacy of radiofrequency cervical zygapophyseal neurotomy in patients with chronic cervicogenic headache. J Korean Med Sci. 2007;22(2):326–9.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Cahana A, Zundert J, Macrea L, Kleef M, Sluijter M. Pulsed radiofrequency: current clinical and biological literature available. Pain Med. 2006;7(5):411–23.PubMedCrossRefGoogle Scholar
  56. 56.
    Erdine S, Ozyalcin NS, Cimen A, Celik M, Talu GK, Disci R. Comparison of pulsed radiofrequency with conventional radiofrequency in the treatment of idiopathic trigeminal neuralgia. Eur J Pain. 2007;11(3):309–13.PubMedCrossRefGoogle Scholar
  57. 57.
    Zundert J, Brabant S, Kelft E, Vercruyssen A, Buyten JP. Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia. Pain. 2003;104(3):449–52.PubMedCrossRefGoogle Scholar
  58. 58.
    Choi HJ, et al. Clinical outcomes of pulsed radiofrequency neuromodulation for the treatment of occipital neuralgia. J Korean Neurosurg Soc. 2012;51(5):281–5.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Vanelderen P, et al. Pulsed radiofrequency for the treatment of occipital neuralgia: a prospective study with 6 months of follow-up. Reg Anesth Pain Med. 2010;35(2):148–51.PubMedCrossRefGoogle Scholar
  60. 60.
    Choi G-S, et al. Short-term effects of pulsed radiofrequency on chronic refractory cervical radicular pain. Ann Rehabil Med. 2011;35(6):826–32.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    van Suijlekom JA, van Kleef M, Barendse G. Radio-frequency cervical zygapophyseal joint neurotomy for cervicogenic headache. A prospective study in 15 patients. Funct Neurol. 1998;13:297–303.PubMedGoogle Scholar
  62. 62.
    Liliang PC, et al. Pulsed radiofrequency lesioning of the suprascapular nerve for chronic shoulder pain: a preliminary report. Pain Med. 2009;10(1):70–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Koyyalagunta D, Burton AW. The role of chemical neurolysis in cancer pain. Curr Pain Headache Rep. 2010;14:261–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Joo YC1, Park JY, Kim KH. Comparison of alcohol ablation with repeated thermal radiofrequency ablation in medial branch neurotomy for the treatment of recurrent thoracolumbar facet joint pain. J Anesth. 2013;27(3):390–5.PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Memorial Sloan Kettering Cancer CenterAnesthesiology and Critical Care MedicineNew YorkUSA
  2. 2.Weill Cornell School of Medicine, Department of AnesthesiologyNew YorkUSA
  3. 3.Department of Anesthesiology/Pain ManagementMemorial Sloan KetteringNew YorkUSA

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