1. Interventional Pain Management in Cancer
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2. Interventional Pain Management
Botulinum Toxin
Acupuncture
Local Blockade
Sympathetic Blocks
Spinal Procedures

3. Botulinum Toxin
Treatment for spasticity, musculoskeletal pain, muscle spasms and neuropathic pain.
Block the release of pain mediators
Radiation induced myokimia and spasticity
Reduced postoperative pain after mastectomy
Reduce pain in muscle spasm after radiotherapy in patients with head and neck cancer.

4. Botulinum Toxin Radiation fibrosis syndrome
Radiation induced dystonia, trigeminal neuralgia, cervical plexus neuralgia
No standard guidelines
Low dose  units per treatment
Relief: 6-12 weeks

5. Acupuncture Stimulating specific discrete anatomic points
Adjunct for pain control, nausea, vomiting post-chemotherapy, back pain
Short term pain relief

6. Local Blockade Local anesthetics Done before proceeding to neurolysis
Intercostal nerves
Cutaneous sensory nerves (trigeminal and saphenous)

7. Local Blockade Neurolysis: Freezing
Application of subzero temperatures
Ice crystals create vascular damage to the vasa nervorum
Used in trigeminal neuralgia and intercostal nerves

8. Local Blockade Neurolysis: Heating Chemical Techniques
Radiofrequency ablation (RF)
Sacroiliac pain, trigeminal neuralgia
Chemical Techniques
Phenol or ethanol preparations

9. Sympathetic Blocks Superior hypogastric plexus Celiac Plexus
Mainly for chronic pelvic cancer pain
Celiac Plexus
Cancer of the abdominal viscera
May cause hypotension and diarrhea.

10. Spinal Procedures Epidural Steroid Injections
Acute radicular pain due to herniated nucleus pulposus.
Earlier pain relief and return to function.

11. Spinal Procedures Vertebral Procedures Tumor involvement of vertebra
Kyphoplasty
Balloon expansion of the vertebrae
Vertebroplasty
Introduces cement to damage vertebra

12. Spinal Procedures Facet Arthropathy Osteoarthiritis and tumor
Intraarticular injection of steroids
Radiofrequency ablation

13. Complementary Therapies for Pain Management in Cancer

14. Complementary Therapies
Acupuncture
Massage Therapy
Hypnosis
Music Therapy
Dietary Supplements

15. Acupuncture Induce analgesics effect Studies: Showed improvement
Short term pain relief

16. Massage Therapy
Stretch and compress a patient’s muscle & connective tissue.
Increased circulation
Stimulation of lymphatic damage
Improve muscle tissue metabolism and elasticity

17. Massage Therapy Reduce anxiety, emotional stress, fatigue.
Effect on physical symptoms
Reduce patient’s need for NSAIDs

18. Hypnosis Altered state of consciousness
A state between wakefulness and sleep
Control of his behavior
Hypnotic analgesia

19. Music Therapy Ease pain, anxiety and depression
Decreased opioid requirement  further study

20. Herbal Remedies Should be cautious
Musculoskeletal pain and arthritic conditions  glucosamine
Glutamine  reducing peripheral neuropathy; dec toxicity of chemotherapy and radiation

21. Thank you...