The role of intrathecal neurolysis in the treatment of cancer-related perianal and perineal pain

Abstract

In this study of intrathecal neurolysis with phenol in nine patients with perianal or perineal cancer-related pain, we found a short duration of pain relief (17.8 days) and a significant incidence of serious side effects, with two patients having permanent urinary retention. The average daily oral morphine dose could be reduced by approximately 20% during this time but in only two out of nine patients could opioids be stopped for a period of four weeks. Conventional analgesic pain treatment based on WHO guidelines remains of paramount importance in the treatment of cancer-related perianal pain, as does the prior utilization of other lower risk techniques before considering the use of intrathecal neurolysis (ITN). Intrathecal or epidural opiates may be a preferable technique for patients with pelvic or perineal pain, and intact bladder and/or bowel function. Improved patient selection, a better understanding of the pathophysiology of the underlying pain, and appropriate timing in performing ITN during the course of the disease may result in higher success rates.

Keywords

analgesia neoplasms nerve block pain subarachnoid space

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References

Smerdlow M. The role of chemical neurolysis. In: Advances in pain research and therapy. New York: Raven Press , 1990: 315.

Lloyd JW Subarachnoid and other clinical uses of phenol. In Racz GB ed, Techniques of neurolysis. Boston. Dordrecht, London: Kluwer Academic Publishers, 1989: 33.

Wells Jcd. The use of nerve destruction for pain relief in cancer: a review. Palliative Medicine 1989; 3: 239.

Patt RB , Jain S. : Recent advances in the management of oncologic pain. In: Stoelting RK ed. Advances in anesthesia. Chicago: Year Book Medical, 1989; 6: 355.

Schroeder ME Neurolytic nerve block for cancer pain. Journal of Pain and Symptom Management 1986; 1: 91.

Sharfman WH , Walsh TD

Has the efficacy of neurolytic celiac plexus block been demonstrated in pancreatic cancer pain?

Pain 1990; 41: 267.

Ferrer-Brecher T. Anesthetic techniques for the management of cancer pain. Cancer 1989; 63: 2343.

International Association for the Study of Pain. Classification of chronic pain. Pain 1986; [Suppl] 3: 1.

Jensen MP , Karoly P. , Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986; 27: 117.

10.

Grond S. , Zech D. , Dahlmann H. , Schug SA , Stobbe B. , Lehmann KA Intractable cancer pain as a reason for referral. Analysis of pain aetiology and previous drug treatment. Schmerz 1990; 4: 193.

11.

Twycross RG , Fairfield S. Pain in far advanced cancer. Pain 1982; 14: 303.

12.

Portenoy RK , Foley KM , Inturissi CE The nature of opioid responsiveness and its implications for neuropathic pain: new hypotheses derived from studies of opioid infusions. Pain 1990; 43: 273.

13.

Walker VA , Hoskin PJ , Hanks GW , White ID Evaluation of WHO analgesic guidelines for cancer pain in a hospital-based palliative care unit. Journal of Pain and Symptom Management 1988; 3: 145.

14.

Ventafridda V. , Tamburini M. , Caraceni A. , De Conno F. , Naldi F. A validation study of the WHO method for cancer pain relief. Cancer 1987; 59: 850.

15.

Schug SA , Zech D. , Dörr U. Cancer pain management according to WHO analgesic guidelines. Journal of Pain and Symptom Management 1990; 5: 27.

16.

Arner S. , Meyerson BA Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain. Pain 1988; 33: 11.

17.

Foley KM , Inturrisi CE Analgesic drug therapy in cancer pain. Principles and practice. Med Clin North Am 1987; 71: 207.

18.

McQuay HJ , Carroll D. , Watts PG , Juniper RP , Moore RA Codeine 20mg increases pain relief from ibuprofen 400mg after third molar surgery. A repeat-dosing comparison of ibuprofen and an ibuprofen-codeine combination. Pain 1989; 37: 7.

19.

Dreschel U. Treatment of cancer pain with neurolytic agents. In: Recent results in cancer research. Berlin: Springer, 1984; 12: 137.

20.

Ferrer-Brecher T. Anesthetic management of cancer pain. Sem Oncol 1985; 12: 431.

21.

Porges P. , Zdrahal F. Intrathecal alcohol neurolysis of the lower sacral roots for incurable carcinoma of the rectum. Anaesthesist 1985; 34: 627.

22.

Arter OE , Racz GB Pain management of the oncologic patient. Sem Surg Oncol 1990; 6: 162.

23.

Blanchard J. , Ramamurthv S. : Subarachnoid alcohol block. In Racz GB ed. Techniques of neurolysis. Boston, Dordrecht, London: Kluwer Academic Publishers, 1989: 45.

24.

Arner S. The role of nerve blocks in the treatment of cancer pain. Acta Anaesth Scand 1982; [Suppl] 74: 104.

25.

Ventrafridda V. , Martino G. Clinical evaluation of subarachnoid neurolytic blocks in intractable cancer pain. In: Bonica JJ , Albe-Fessard D eds. Advances in pain research and therapy. New York: Raven Press, 1976; 2: 699.

26.

Swerdlow M. Current views on intrathecal neurolysis. Anesthesia 1978; 33: 733.

27.

Watson Cpn , Evans RJ Intractable pain with cancer of the rectum. Pain Clinic 1986; 1: 29.

28.

Cleeland RS , Rotondi A. , Brechner T. et al. A model for treatment of cancer pain . Journal of Pain and Symptom Management 1986 ; 1: 209.

29.

Radbruch L. , Zech D. , Grond S. , Meuser T. , Lehmann KA Perianalschmerz und Rektumkarzinom- Prävalenz beim Lokalrezidiv. Med Klin 1991; 86: 180.