Background: Interventional treatments are becoming more popular in addressing pain management in outpatient settings for cancer patients. These treatments include neurolysis, nerve block, neuromodulatory techniques, and novel drug delivery systems. To better understand patients’ available options for managing their cancer-related pain, we conducted this literature review. Methods: NIH database, Cochrane library, and Embase were thoroughly searched, and inclusion or exclusion criteria were selected. Risk assessment was conducted using the MINORS, Cochrane, and JBI criteria. Results are described following PRISMA guidelines and utilizing a 96% confidence interval to denote statistical significance. Results: The initial search yielded 2673 results; after excluding all non-relevant and high risk of bias studies, 15 were included for final analysis. In Neurolysis, 3 techniques were identified: pulsed radiofrequency ablation (PRF), thermal radiofrequency ablation (TRF), and chemical injection. Nerve blocks target specific sensory nerve fibres through nociceptors and mechanoreceptors to reduce signaling. Neuromodulatory techniques stimulate nerves to reduce pain and include TENS and scrambler therapy. Drug delivery systems allow intrathecal analgesia via an implanted pump to deliver medication directly to the site of pain. Notably, in delivering opioids intrathecally, there is the benefit of avoiding opioid-related side effects secondary to systemic opioids. Discussion: The neurolytic intervention with standard analgesic therapy in these clinical trials reported pain relief in refractory cancer-related pain and all three studies addressing nerve blocks found a statistically significant decrease in VAS scores compared to baseline. These studies suggest that further innovations like fluoroscopic guidance in nerve block administration may improve its effectiveness and accessibility. For drug delivery systems, there is good utility in allowing targeted therapy but more specific studies should be pursued to decide between types of drug delivery systems. Some limitations in this review were that studies used different criteria to score pain and utilized different follow-up timelines, making it difficult to compare results directly. Each of the RCTs and clinical trials was limited in their generalizability. Further research will help utilize interventional procedures to both first-line and refractory settings in the outpatient setting.
BPI23-016: Interventional Pain Management in Outpatient Setting for Cancer Patients: A Review of Literature
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FNU Anamika
MD
FNU Anamika
Hackensack Meridian Ocean University Medical Center, Brick, NJ
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Akshit Chitkara
MD
Akshit Chitkara
University of California, Riverside, CA
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Anh-Tram Bui
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Anh-Tram Bui
Western University of Health Sciences, Pomona, CA
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Quang Nguyen
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Quang Nguyen
California University of Sciences and Medicine, Fontana, CA
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Arshia Adib
MD
Arshia Adib
Hindu Rao Hospital, Delhi, India
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Pramil Cheriyath
MD
Pramil Cheriyath
Hackensack Meridian Ocean University Medical Center, Brick, NJ
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Karamjeet Sandhu
MD
Karamjeet Sandhu
City of Hope NCI, Duarte, CA
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