Peripheral Nerve Blocks in Palliative Care for Cancer Patients

  • Zbigniew (Ben) ZyliczEmail author


Despite rapid developments in oncology, cancer patients often suffer pain. Pain in cancer is not one single entity and does not respond to one drug. Although opioid consumption is rapidly increasing, many kinds of cancer pain do not respond to it. A more differentiated diagnosis and treatment is necessary. Nerve compression pains tend to be a serious and undervalued problem, and they respond slightly or not at all to standard analgesics. This chapter presents the most recent views on the etiology of nerve compression in cancer and describes several nerve compression syndromes that can be easily treated, at the bedside, with injection of local anesthetics and corticosteroids. Interestingly, most of these syndromes were described decades ago but neglected in the era of modern imaging techniques, as most of the small cutaneous nerves remain invisible. The nerve compression syndromes are different from those observed in the general population. Most of the compressed nerves are located on the rear side of the body, which suggests that long-lasting stays in bed in the recumbent position are an important factor.


Peripheral nerve blocks Nerve infiltrations Local anesthetics Palliative care Cancer pain 


  1. 1.
    Silbermann M. Current trends in opioid consumption globally and in Middle Eastern countries. J Pediatr Hematol Oncol Off J Am Soc Pediatr Hematol Oncol. 2011;33 Suppl 1:S1–5.Google Scholar
  2. 2.
    van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18:1437–49.CrossRefGoogle Scholar
  3. 3.
    Zylicz Z. Noncancer related pain in daily practice. In: Hanna M, Zylicz Z, editors. Cancer pain. London: Springer; 2013. p. 191–202.CrossRefGoogle Scholar
  4. 4.
    Zylicz Z, Twycross R. Opioid-induced hyperalgesia may be more frequent than previously thought. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26:1564.CrossRefGoogle Scholar
  5. 5.
    Childs SG. Double crush syndrome. Orthop Nurs. 2003;22:117–21; quiz 22–3.CrossRefPubMedGoogle Scholar
  6. 6.
    Abdi S, Datta S, Trescot AM, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10:185–212.PubMedGoogle Scholar
  7. 7.
    Manchikanti L. Role of neuraxial steroids in interventional pain management. Pain Physician. 2002;5:182–99.PubMedGoogle Scholar
  8. 8.
    Chambers WA. Nerve blocks in palliative care. Br J Anaesth. 2008;101:95–100.CrossRefPubMedGoogle Scholar
  9. 9.
    Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg. 2010;28(1):3–16.Google Scholar
  10. 10.
    Zylicz Z, Haijman J. Suprascapular nerve entrapment: a neglected cause of shoulder pain in cachectic patients? J Pain Symptom Manage. 2000;20:315–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Dekhuijzen PN, Decramer M. Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur Respir J. 1992;5:997–1003.PubMedGoogle Scholar
  12. 12.
    Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9:336–44.CrossRefPubMedGoogle Scholar
  13. 13.
    Maigne JY, Lazareth JP, Guerin Surville H, Maigne R. The lateral cutaneous branches of the dorsal rami of the thoraco-lumbar junction. An anatomical study on 37 dissections. Surg Radiol Anat. 1989;11:289–93.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Oeitender Arzt, Palliative Care TeamUniversity HospitalBaselSwitzerland

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