Pros and Cons of Different Approaches to the Management of Pelvic Cancer Pain
Pain due to malignancy in the pelvic region is common and notoriously difficult to relieve. One important reason why this condition often fails to respond both to pharmacological and surgical treatment is that the genesis of the pain may be very complex as the pathological process may involve different types of tissue and organs. Thus, the pain may originate from the viscera, connective tissue, bone, and, of particular significance, from nervous tissue. Pelvic pain often radiates in the hip region or in the leg as a result of injury to the lumbo-sacral plexus, and it is wellknown that neurogenic pain, especially when there is a component of deafferentation, is extremely difficult to alleviate. As will be further discussed in this paper the pain analysis is therefore of utmost importance for the selection of a proper method of treatment. A further characteristic of pelvic cancer pain, which sometimes accounts for therapy failure is that such pain is often poorly localized and has a tendency to be feit in the midline or with bilateral spreading. Some of the destructive procedures available for malignant pain appear to be most suitable for pain confined to one side (cordotomy, neurolytic blocks) and when applied with the aim of producing bilateral effects the risk of serious side-effects and complications is considerably increased.
KeywordsCancer Pain Epidural Morphine Pelvic Region Pelvic Cancer Neurogenic Pain
Unable to display preview. Download preview PDF.
- 5.Laitinen, L. V., Anterior cingolotomy in the treatment of intractable pain. In: Neurosurgical Treatment in Psychiatry, Pain and Epilepsy (Sweet, W. H., etal., eds.). Baltimore: University Park Press. 1977.Google Scholar
- 6.Lipton, S., Percutaneous cervical cordotomy. In: Advances in Pain Research and Therapy, Vol. 2 (Bonica, J. J., Ventrafridda, V., eds.), pp. 425–437. New York: Raven Press. 1979.Google Scholar
- 8.Mansuy, L., Sindou, M., Fischer, G., Brunon, J., La cordotomie spinothalamique dans les douleurs cancereuses. Neurochir. 22: 5 (1976), 437–444.Google Scholar
- 10.Meyerson, B. A., Electrostimulation procedures: effects, presumed rationale, and possible mechanisms. In: Advances in Pain Research and Therapy, Vol. 5 (Bonica, J. J., etal., eds.), pp. 495–534. New York: Raven Press. 1983.Google Scholar
- 11.Poletti, C. E., Cohen, A. M., Todd, D. P., Ojemann, R. G., Sweet, W. H., Zervas, N. T., Cancer pain relieved by long-term epidural morphine with permanent indwelling systems for self-administration. J. Neurosurg. 55 (1982), 581–584.Google Scholar
- 13.Tasker, R. R., Percutaneous cordotomy–the lateral high cervical technique. In: Operative Neurosurgical Techniques, Vol. 2 (Schmidek, H. H., Sweet, W. H., eds.), pp. 1137–1153. New York: Grüne and Stratton. 1982.Google Scholar
- 15.Zenz, M., Piepenbrock, S., Schappler-Scheele, B., Hüsch, M., Peridurale Morphineanalgesie: III. Karcinomschmerz. Anesthesist30 (1982), 508–513..Google Scholar