Interventional Pain Management for Hospice Patients

Most patients with cancer pain achieve good analgesia using traditional analgesics and adjuvant medications. However,  an important minority (5-10%) of patients suffer from severe and refractory cancer pain controlled adequately, even with optimal medical therapy. This has led to the recommendation that the World Health Organization ladder have a fourth step, which consists of interventional procedures and techniques. Interventional pain therapies are a set of techniques for pain control that may be useful when aggressive systemic analgesics fail to provide adequate control of cancer pain or when the adverse effects of systemic analgesics become problematic. Compared with systemic analgesics, which generally have broad indications for control of pain, individual interventional therapies generally have specific, narrow indications. When appropriately selected and implemented, interventional pain therapies become important components of broad, multimodal cancer pain management that significantly increases the proportion of patients able to experience adequate pain control. Palliative care specialists often encounter patients who have had, or are receiving, interventional therapies in a variety of settings including the inpatient, outpatient and hospice settings. Understanding when and how to use these important techniques will assist in the management of patients with severe cancer pain and will enhance practioner confidence and patient care.