Pain Control and Palliative Treatments

  • Marco CascellaEmail author
  • Francesca Bifulco
  • Barbara Di Caprio
  • Arturo Cuomo
Part of the Updates in Surgery book series (UPDATESSURG)


In pelvic diseases, pain is a common and debilitating symptom with variable etiology. It can occur suddenly, sharply, and briefly (acute pelvic pain) or over the long term (chronic pelvic pain). Chronic pelvic pain refers to any constant or intermittent pelvic pain and is defined in a variety of ways. The most commonly used definitions consider both pain location and duration. In 1994, Campbell and Collett [1] defined it as “recurrent or constant pain in the lower abdominal region that has lasted for at least six months”. A similar definition was proposed by the American Congress of Obstetricians and Gynecologists: “non-cyclic pain of six or more months’ duration that localizes to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks, and is of sufficient severity to cause functional disability or lead to medical care” [2].


Neuropathic Pain Cancer Pain Interstitial Cystitis Chronic Pelvic Pain Locally Advanced Rectal Cancer 
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  1. 1.
    Campbell F, Collett BJ (1994) Chronic pelvic pain. Br J Anaesth 73(5):571–573CrossRefPubMedGoogle Scholar
  2. 2.
    ACOG Committee on Practice Bulletins – Gynecology (2004) ACOG Practice Bulletin No. 51. Chronic pelvic pain. Obstet Gynecol 103(4):589–605Google Scholar
  3. 3.
    Costigan M, Scholz J, Woolf CJ (2009) Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci 32:1–32CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Zondervan KT, Yudkin PL, Vessey MP et al (1999) Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol 106(11):1149–1155CrossRefPubMedGoogle Scholar
  5. 5.
    Mathias SD, Kuppermann M, Liberman RF et al (1996) Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 87(3):321–327CrossRefPubMedGoogle Scholar
  6. 6.
    Casey EB, Jellife AM, Le Quesne PM, Millett YL (1973) Vincristine neuropathy. Clinical and electrophysiological observations. Brain 96(1):69–86CrossRefPubMedGoogle Scholar
  7. 7.
    Weng HR, Cordella J V, Dougherty PM (2003) Changes in sensory processing in the spinal dorsal horn accompany vincristine-induced hyperalgesia and allodynia. Pain 103(1-2):131–138CrossRefPubMedGoogle Scholar
  8. 8.
    Jacox A, Carr DB, Payne R (1992) Management of cancer pain. Clinical practice guideline no. 9. U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; Rockville: MDGoogle Scholar
  9. 9.
    Miaskowski C, Cleary J, Burney R et al (2005) Guideline for the management of cancer pain in adults and children. American Pain Society: GlenviewGoogle Scholar
  10. 10.
    World Health Organization (1996) Cancer pain relief with a guide to opioid availability, 2nd ed. World Health Organization: GenevaGoogle Scholar
  11. 11.
    Jadad AR, Browman GP (1995) The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA 274(23):1870–1873CrossRefPubMedGoogle Scholar
  12. 12.
    Zech DF, Grond S, Lynch J et al (1995) Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain 63(1):65–76CrossRefPubMedGoogle Scholar
  13. 13.
    Cleeland CS, Mendoza TR, Wang XS et al (2000) Assessing symptom distress in cancer patients: the M.D. Anderson Symptom inventory. Cancer 89(7):1634–1646CrossRefPubMedGoogle Scholar
  14. 14.
    Derry S, Wiffen PJ, Aldington D, Moore RA (2015) Nortriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 2015;1:CD011209Google Scholar
  15. 15.
    Lunn MP, Hughes RA, Wiffen PJ (2014) Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev 2014;1:CD007115Google Scholar
  16. 16.
    Moore RA, Wiffen PJ, Derry S et al (2014) Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2014;4:CD007938.Google Scholar
  17. 17.
    Ripamonti CI, Santini D, Maranzano E et al (2012) Management of cancer pain: ESMO clinical practice guidelines. Ann Oncol 23(suppl 7):vii139–vii154CrossRefPubMedGoogle Scholar
  18. 18.
    Caraceni A, Hanks G, Kaasa S and the European Palliative Care Research Collaborative (EPCRC) and the European Association for Palliative Care (EAPC) (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13(2):e58–e68CrossRefPubMedGoogle Scholar
  19. 19.
    Camilleri M (2011) Opioid-induced constipation: challenges and therapeutic opportunities. Am J Gastroenterol 106(5):835–843CrossRefPubMedGoogle Scholar
  20. 20.
    Cuomo A, Russo G, Esposito G et al (2014) Efficacy and gastrointestinal tolerability of oral oxycodone/naloxone combination for chronic pain in outpatients with cancer: an observational study. Am J Hosp Palliat Care 31(8):867–876CrossRefPubMedGoogle Scholar
  21. 21.
    American Pain Foundation (2011) Breakthrough cancer pain: mending the break in the continuum of care. J Pain Palliat Care Pharmacother 25(3):252–264CrossRefPubMedGoogle Scholar
  22. 22.
    World Health Organization (1997) Traitement de la douleur cancéreuse, World Health Organization: GenevaGoogle Scholar
  23. 23.
    Eisenberg E, Marinangeli F, Birkhahm J et al (2005) Time to modify the WHO analgesic leader? Pain Clin Update 13(5):1–4Google Scholar
  24. 24.
    Gómez-Cortéz MD, Rodríguez-Huertas F (2000) Reevaluación del segundo escalón de la escalera analgésica de la OMS. Rev Soc Esp Dolor 7(6):343–344Google Scholar
  25. 25.
    Vargas-Schaffer G (1999) Manejo y tratamiento del dolor oncológico. In: Vargas-Schaffer G, Esposito Quercia G, editors. Dolor y cuidados paliativos en oncologia. evaluación, manejo y tratamiento. Ediciones Expansión Científica G&S: Caracas, pp. 79–93Google Scholar
  26. 26.
    Grisell Vargas-Schaffer (2010) Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 56(6):514–517Google Scholar
  27. 27.
    Krakowski I, Falcoff H, Gestin Y et al (1998) Recommandation pour une bonne pratique dans la prise en charge de la douleur du cancer chez l’adulte et l’enfant. Nice, Fr: Societé Française de la Douleur, Agency for Health Care Policy and Research, pp. 11–15Google Scholar
  28. 28.
    Caraceni A, Portenoy R K (1996) Pain management in patients with pancreatic carcinoma. Cancer 78(3 Suppl):639–653CrossRefPubMedGoogle Scholar
  29. 29.
    de Leon-Casasola OA, Kent E, Lema MJ (1993) Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain 54(2):145–151CrossRefPubMedGoogle Scholar
  30. 30.
    Plancarte R, Amescua C, Patt RB, Aldrete JA (1990) Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology 73(2):236–239CrossRefPubMedGoogle Scholar
  31. 31.
    Plancarte R, de Leon-Casasola OA, El-Helaly M et al (1997) Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth 22(6):562–568PubMedGoogle Scholar
  32. 32.
    Christo J, Hobelmann G (2009) Pelvic Pain. In: Smith HS (ed) Current Therapy in Pain. 1st edn. Saunders-Elsevier: Philadelphia, pp. 216–227CrossRefGoogle Scholar
  33. 33.
    Waldman S (2009) Hypogastric Plexus Block. In: Waldman SD (ed) Pain review. 1st edn. Saunders-Elsevier: Philadelphia, pp. 538–541CrossRefGoogle Scholar
  34. 34.
    Waldman S (2004) Atlas of Interventional Pain Management. 2nd edn. Saunders-Elsevier: PhiladelphiaGoogle Scholar
  35. 35.
    Plancarte R, Amescua C, Patt RB, Allende S (1990) Presacral blockade of the ganglion of Walter (ganglion impar). Anesthesiology 73(3A):A751Google Scholar
  36. 36.
    Gupta D, Jain R, Mishra S et al (2008) Ultrasonography reinvents the originally described technique for ganglion Impar neurolysis in perianal cancer pain. Anesth Analg 107(4):1390–1392CrossRefPubMedGoogle Scholar
  37. 37.
    Malec-Milewska M, Horosz B, Kolęda I et al (2014) Neurolytic block of ganglion of Walther for the management of chronic pelvic pain. Wideochir Inne Tech Malo Inwazyjne 9(3):458-462PubMedCentralPubMedGoogle Scholar
  38. 38.
    Ohhigashi S, Nishio T, Watanabe F, Matsusako M (2001) Experience with radiofrequency ablation in the treatment of pelvic recurrence in rectal cancer: report of two cases. Dis Colon Rectum 44(5):741–745CrossRefPubMedGoogle Scholar
  39. 39.
    Wilsey C, Ashford NS, Dolin SJ (2002) Presacral neurolytic blocks for relief of pain from pelvic cancer: description and use of CT Guided lateral approach. Palliat Med 16(5):441–444CrossRefPubMedGoogle Scholar
  40. 40.
    Zekry HA, Reddy SK (1999) Opioid and nonopioid therapy in cancer pain: the traditional and the new. Curr Rev Pain 3(3):237–247CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Marco Cascella
    • 1
    Email author
  • Francesca Bifulco
  • Barbara Di Caprio
  • Arturo Cuomo
  1. 1.Department of Anesthesia, Endoscopy, and CardiologyIstituto Nazionale Tumori - IRCCS Fondazione G. PascaleNaplesItaly

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