Nonpharmacological Management of Cancer Pain

It has become traditional to separate discussion on the management of intractable pain into the arbitrary categories of cancer pain and benign pain. Based on physiological considerations, this is somewhat capricious and probably not always accurate. Certainly patients with malignancy predominantly suffer form nociceptive pain due to direct tissue damage by tumor invasion or compression. However, those patients also suffer from neuropathic pain. In general, patients with terminally ill cancer patients have a somewhat limited life span. This factor is one of the most important when considering the surgical procedure. There has been a resurgence of interest in neurosurgical procedure in the management of cancer pain. Functional stereotactic procedures for cancer pain are divided into two broad categories: ablative and neuroaugmentative. Many patients with intractable pain secondary to malignancy respond better to surgical procedures than do patients without malignancy. And cancer pain is most often responding well with narcotics. However, the recent development of various oral and systemic narcotics has dramatically changed the management of pain secondary to cancer. In addition, a number of technical advances have made it much easier to deliver medication on outpatient basis. All these modalities in combination have dramatically reduced the need of nonpharmacological procedures for patients with cancer pain. However, once these measures have failed, it is appropriate to consider surgical interventionope