title: Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder?
abstract: BACKGROUND
  For most patients with cancer pain, the World Health Organization's three-step analgesic ladder provides adequate management with oral or transdermal options. However, some cancer patients are not well palliated with these approaches.
  
  
  METHODS
  The author reviews interventional options that include nerve blocks, spinal administration of local anesthetics, opioids, alpha-2 agonists, spinal cord stimulation, and surgical interventions.
  
  
  RESULTS
  Numerous interventional options are readily accessible and most can be performed on an outpatient basis. They can be used as sole agents for the control of cancer pain or as useful adjuncts to supplement analgesia provided by opioids, thus decreasing opioid dose requirements and side effects.
  
  
  CONCLUSIONS
  Cancer-related pain can be controlled with several interventions when oral or transdermal opioids are inadequate. A risk:benefit ratio should be considered before implementing invasive analgesic methods.
authors.affiliation: Anesthesiology Service, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
authors.forename: R
authors.initials: R
authors.lastname: Miguel
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004558:Electric Stimulation; D006801:Humans; D007278:Injections, Spinal; D009369:Neoplasms / Q000503:physiopathology*; D009407:Nerve Block; D010148:Intractable Pain / Q000628:therapy*; D012597:Sclerosing Solutions / Q000627:therapeutic use; D013116:Spinal Cord / Q000502:physiology; D014944:World Health Organization
chemical_list: D000701:Analgesics, Opioid; D012597:Sclerosing Solutions