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Interventional Pain Management For Cancer Patients

Interventional Pain Management For Cancer Patients. Prof. Krishna Boddu . MBBS, MD (Anes), DNB, FANZCA, MMEd. Director, Regional Anaesthesia Anaesthesia & Pain Medicine Royal Perth Hospital. Modern Palliative Care Is Supportive Care & Symptom Control Says.

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Interventional Pain Management For Cancer Patients

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  1. Interventional Pain Management For Cancer Patients Prof. Krishna Boddu . MBBS, MD (Anes), DNB, FANZCA, MMEd. Director, Regional Anaesthesia Anaesthesia & Pain Medicine Royal Perth Hospital

  2. Modern Palliative Care Is Supportive Care & Symptom Control Says.. World’s Largest No 1 Cancer Center (Treats 115,000 patients/year and Employs 19,000)

  3. Memorial Hermann Hospital • Certified Level I trauma centers in the greater Houston • > 40000 Emergency and trauma care patients a year • Life Flight® air ambulance service – Providing emergency rescue and air transport services • 165,000-square-foot HVI for latest innovations in cardiology programs and treatment. • 30-story medical office building (Medical Plaza), an Ambulatory Care Center, retail shops, services, restaurants etc We are proud of our institutions in many ways

  4. Epidemiology of Cancer & Cancer Pain • >6.35 million new cases / year • WHO Estimate: By 2021, 15 million new cases/ year • Only 50% of cases are undergoing treatment • > 90% of patients with advanced cancer have pain. 10% Past Chronic Pain 25% 10% 25% Pain due to cancer therapy 70-75% 70 - 75% Tumor involvement of organic structures Portenoy RK, Cancer Pain: Epidemiology and syndromes Cancer 1989; 63:2307 WHO Cancer Pain Relief 1986

  5. Where do we stand in providing good pain control For Cancer Pain Patients? Freedom From Cancer Pain Non-Opioids + Opioid + Interventional Cancer Pain After Surgery Non-Opioids + Opioid Non-Opioids +Codine Non-opioid (Tylenol + NSAID + Tramadol) Cancer Pain

  6. Some Pain Control Techniques

  7. Early Intervention Is New Concept How Can We Justify? Advanced Pain Rx Better Pain Control Advanced Cancer Rx Prolongation of Life Span Such Success has an ARTIFACT Methods Available to Provide Cost Effective Interventional Pain Relief Accentuates: Pain & Suffering Increased Need of Palliative Care Services Minimize pain and suffering that incur considerable loss — of time, experience, and sense of self Clearly, Moral Obligation Exists to Relieve Pain & Suffering When cure is impossible, palliation remains the only viable alternative. But, Technically Effective Care Must Also Be Rendered For the patient who is dying from end-stage terminal illness, such suffering can purloin what time is remaining, and thus diminishes the capacity for meaningful reflection and relational closure with loved ones, and the life-lived, in general

  8. Common Symptoms Managed in Cancer Patients Are… Common Side Effects of Opioid Management Are…. • Pain • Fatigue • Dyspnea • Anorexia/ Cachexia • Nausea/ Vomiting • Depression • Anxiety • Constipation • Insomnia • Opioid Tolerance • Fatigue • Resp Depression • Anorexia • Nausea/ Vomiting • Urinary Retention • Itching • Constipation • Insomnia/Hallucinations

  9. Nerve Blocks Catheters in Palliative Care

  10. Presumed Barriers to InterventionalPain Management in Cancer Patients 3. Need To Repeat Pain Procedures May Be Unjustifiably Burdensome To Patients At End Of Life, Or Who Require Long-term Care 1. Claimed Not Worth the Cost 2. Analgesia From Interventional Techniques Is Short Acting for the Cost It is a fact that interventional pain management procedures were originally developed for use in the frail elderly who were unable to tolerate polypharmacologic or surgical interventions when compared with long-term use of systemically administered primary and djunctive/adjuvant analgesics, interventionaltechniques reveal a very favorable cost:benefit ratio It is a misconception given that analgesia from neurolytic blocks typically lasts for months 4. Lack of Availability Of Interventional Pain Specialists To Render Treatment Within The Cancer/ Palliative Care Setting Is Limited All most all urban areas, multispecialist interventional pain specialists can be found

  11. Benefits and Potential of Interventional Pain Management in Cancer Patients • Single procedure, the patient can be afforded months of pain relief • Significant reduction in opioid dose, thereby increasing the response to opioids and/or non-opioid agents • Often the best, or perhaps the only way to manage certain pain syndromes that are commonly encountered in the cancer care setting

  12. Interventional Procedures: Opioid Pumps Opioids : Sub Cu/ Epidural/ Spinal Morphine: 3mg PO=1mg IV =0.1mg Epidural=0.01mg Spinal Refractory Cancer Pain Life Expectancy > 3mo Life Expectancy < 3mo Some Pain Relief Single Shot Intrathecal Trial Epidural Catheter Tunneled >50% Pain Relief Implant Pump • IT Catheter Trial Medical Management

  13. Nerve Blocks Local Anaesthetic Nerve Blocks Neurolytic Nerve Blocks Diagnostic Nerve Blocks Alcohol Phenol RF Cryo Therapeutic Nerve Blocks Chemical Heat Cold Painful/ Not Painful on injection Onset of action varies Several Months Relief

  14. To achieve Good Pain Control For Cancer Patients, We need to bridge the gap between our teams

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