背景:疼痛是癌症患者中最常见的症状。为了改善疼痛护理,世界卫生组织(WHO)疼痛阶梯于1986年推出,作为在肿瘤环境中选择疼痛药物的模板。从那以后,肿瘤治疗的进步提高了癌症患者的生存率,在不同的治疗阶段需要长时间的镇痛。此外,在阿片类药物流行和相关阿片类药物使用障碍的疼痛管理方面出现了新的挑战.这已将重点从WHO疼痛阶梯转移,并为癌症疼痛管理的介入疼痛模式的快速发展领域带来了新的重要性。本文回顾了此类介入疼痛和微创神经外科手术治疗癌症患者疼痛的选择。
方法:PubMed系统文献检索,科克伦,和Embase。这包括评论文章,随机对照试验,非随机临床试验(RCT),案例系列。
结果:肿瘤疼痛管理有大量的介入疼痛模式。这些方式具有相对较低的风险,并提供有效的镇痛,同时减少与阿片类药物使用障碍有关的担忧。它们针对解剖和生理疼痛途径的各个领域,并为癌症和幸存者的各个阶段的疼痛管理提供更有针对性的选择。此外,通过改进的无菌技术,更好的成像方式,以及不断增长的技术和临床专业知识,介入疼痛模式提供了一种安全且通常更有效的疼痛管理方法。手术方式,如鞘内(IT)泵,神经调节,椎体后凸成形术,新的更有针对性的消融技术现在越来越多地在癌症人群中发现更多的作用和适应症。
结论:介入疼痛技术正在迅速发展,并已成为癌症疼痛管理不可或缺的一部分。它们可以为癌症疼痛管理提供额外的选择,可以帮助减少阿片类药物的消耗,和相关的阿片类药物副作用。随着成像模式的改进,程序技术,硬件,和感染控制,它们具有良好的安全性,并为癌症疼痛管理提供了快速有效的方法。这篇综述文章旨在提供对各种介入性疼痛模式的基本理解,他们的适应症,功效,安全数据,和相关的并发症。
BACKGROUND: Pain is the most prevalent symptom in cancer patients. To improve pain care, World Health Organization (WHO) Pain ladder was introduced in 1986 as a template for choosing pain medications in oncological settings. Since then, advancements in oncological treatments have improved the survival of cancer patients, requiring prolonged analgesia in various treatment stages. Additionally, there have been newer challenges in pain management with opioid epidemic and associated opioid use disorders. This has shifted the focus from WHO Pain Ladder and brought new importance to the rapidly evolving realm of interventional pain modalities for cancer pain management. This article reviews such interventional pain and minimally invasive neurosurgical options for pain management in cancer patients.
METHODS: Systemic literature search in PubMed, Cochrane, and Embase. This included
review articles, randomized controlled trials, non-randomized clinical trials (RCTs), and case series.
RESULTS: A large array of interventional pain modalities are available for oncological pain management. These modalities carry relatively lower risk and provide effective analgesia while reducing concerns related to opioid use disorder. They target various areas in the anatomical and physiological pain pathways and provide more focused options for pain management at various stages of cancer and survivorship. Additionally, with improved sterile techniques, better imaging modalities, and growing technical and clinical expertise, interventional pain modalities offer a safe and often more efficacious method of pain management nowadays. Procedural modalities like intrathecal (IT) pumps, neuromodulation, kyphoplasty, and newer more targeted ablative techniques are now increasingly finding more roles and indications in cancer population.
CONCLUSIONS: Interventional pain techniques are rapidly evolving and have become an integral part of cancer pain management. They can provide an additional option for cancer pain management, and can help reduce opioid consumption, and associated opioid side effects. With improvement in imaging modalities, procedural techniques, hardware, and infection control, they have a good safety profile and provide a rapid and efficacious approach for cancer pain management. This
review articles aims to provide a basic understanding of various interventional pain modalities, their indications, efficacy, safety data, and associated complications.