The manifestation of pain in patients with cancer is common and debilitating. Epidemiological studies highlight that about a quarter of patients with newly-diagnosed malignancies experience pain and a substantial portion are refractory to conventional management. The cause of pain in cancer patients may be related to the primary cancer itself, spread to other organ systems from metastases, cancer-related treatment (surgery, chemotherapy, radiation therapy), and other complications. The most widely used interventional approaches to treat cancer-related pain include local anesthetic and steroid injections, neuraxial analgesia, and sympathetic block. Recent evidence has highlighted that neuromodulation interventions may offer another modality that is effective in treating cancer-related pain. Preliminary evidence may also support that neuromodulation may affect chemosensitivity and tumor growth, although future studies are warranted.
Upon completion of this educational activity, participants should be able to:
- Identify the various manifestations of cancer-related pain and conventional management used to treat cancer-related pain.
- Summarize clinical outcomes (pain intensity, physical function, satisfaction, mental health, adverse events) of dorsal-column spinal cord stimulation, dorsal root ganglion spinal cord stimulation, and peripheral nerve stimulation for chemotherapy-induced and radiation-induced peripheral neuropathy.
- Describe clinical outcomes (pain intensity, physical function, satisfaction, mental health, adverse events) of intrathecal drug delivery systems (IDDS) for cancer-related pain.
- Discuss preliminary results of how neuromodulation may affect chemosensitivity and tumor growth (e.g. suppression of tumor growth).
Dorsal Column Spinal Cord Stimulation for Cancer Pain
Sandy Christiansen, MD
Dorsal Root Ganglion Stimulation and Peripheral Nerve Stimulation for Cancer Pain
Amitabh Gulati, MD
Intrathecal Drug Delivery Systems for Cancer Pain
Pritesh Topiwala, MD
Pathophysiological Changes and Chemosensitivity After Neuromodulation in Cancer Patients
Eellan Sivanesan, MD
Faculty subject to change.