Percutaneous-guided pain control: exploiting the neural basis of pain sensation.
The gastroenterologist deals frequently with painful conditions and suffering patients. Performing regular pain assessments and applying basic pain medicine principles will augment the care of patients in pain. Percutaneous-guided pain therapy techniques play a role in the multidisciplinary approach to pain medicine. Systemic opioid analgesia is the primary means of controlling cancer pain. However, 10% to 15% of cancer patients may need additional interventions to control pain. Sympathetic ganglion nerve blocks with neurolytic agents such as alcohol or phenol are reserved mostly for cancer pain. The efficacy and safety of these tools are validated by several decades of clinical application and published studies. Although the procedures are operator-dependent, in the hands of experienced clinicians, patients achieve sustained relief in the majority of cases. Although these techniques have been attempted in some benign conditions,such as chronic pancreatitis, with limited success, studies of newer imaging localization techniques such as endoscopic ultrasonography may expand future indications. Patients of the gastroenterologist who experience malignant abdominal pain may benefit from referral for percutaneous-guided pain control techniques.
Adolph
Michael D
MD
Arthur G. James Cancer Hospital, Richard J. Solove Research Institute, Ohio State University College of Medicine and Public Health, 400 West 10th Avenue, Suite 511, Columbus 43210, USA.
Benedetti
Costantino
C
D000208:Acute Disease; D000698:Analgesia / Q000379:methods*; D001340:Autonomic Nerve Block; D002447:Celiac Plexus; D002908:Chronic Disease; D005767:Gastrointestinal Diseases / Q000150:complications*; D006801:Humans; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D059408:Pain Management; D012677:Sensation