Invasive Interventions to Relieve Pain

Less invasive methods should be used for relieving pain before trying invasive treatment. Some patients, however, may need invasive therapy.

Nerve Blocks

A nerve block is the injection of either a localanesthetic or a drug that inactivates nerves to control otherwise uncontrollable pain. Nerve blocks can be used to determine the source of pain, to treat painful conditions that respond to nerve blocks, to predict how the pain will respond to long-term treatments, and to prevent pain following procedures.

Neurologic Interventions

Surgery can be performed to implant devices that deliver drugs or electrically stimulate the nerves. In rare cases, surgery may be done to destroy a nerve or nerves that are part of the pain pathway.

Management of Procedural Pain

Many diagnostic and treatment procedures are painful. Pain related to procedures may be treated before it occurs. Local anesthetics and short-acting opioids can be used to manage procedure-related pain, if enough time is allowed for the drug to work. Anti-anxiety drugs and sedatives may be used to reduce anxiety or to sedate the patient. Treatments such as imagery or relaxation are useful in managing procedure-related pain and anxiety.

Patients usually tolerate procedures better when they know what to expect. Having a relative or friend stay with the patient during the procedure may help reduce anxiety.

Patients and family members should receive written instructions for managing the pain at home. They should receive information regarding whom to contact for questions related to pain management.

Treating Older Patients

Older patients are at risk for under-treatment of pain because their sensitivity to pain may be underestimated, they may be expected to tolerate pain well, and misconceptions may exist about their ability to benefit from opioids. Issues in assessing and treating cancer pain in older patients include the following:

• Multiple chronic diseases and sources of pain: Age and complicated medicationregimens put older patients at increased risk for interactions between drugs and between drugs and the chronic diseases.
• Visual, hearing, movement, and thinking impairments may require simpler tests and more frequent monitoring to determine the extent of pain in the older patient.
• Nonsteroidal anti-inflammatory drug (NSAID) side effects, such as stomach and kidneytoxicity, thinking problems, constipation, and headaches, are more likely to occur in older patients.
• Opioid effectiveness: Older patients may be more sensitive to the pain-relieving and central nervous system effects of opioids resulting in longer periods of pain relief.
• Patient-controlled analgesia must be used cautiously in older patients, since drugs are slower to leave the body and older patients are more sensitive to the side effects.
• Other methods of administration, such as rectal administration, may not be useful in older patients since they may be physically unable to insert the medication.
• Pain control after surgery requires frequent direct contact with health care providers to monitor pain management.
• Reassessment of pain management and required changes should be made whenever the older patient moves (for example, from hospital to home or nursing home).