Pain in Cancer-Related Conditions

Pain is a common symptom in cancer patients. Approximately one-third of patients experience pain at the time of diagnosis, and 60% of patients with advanced cancer live with untreated pain.

The management of cancer-related pain varies from patient to patient; however, one thing can be clearly stated: with modern pain management methods, cancer-related pain can be reduced, managed, and often eliminated in most cases, thereby improving the patient’s quality of life1,2.

What Type of Pain Does Cancer Cause?

The symptoms of cancer-related pain vary from person to person. The severity of pain may depend on the type of cancer, the stage or extent of the disease, and the location of metastases.

Pain may be mild or severe, intermittent or constant, and may present as:

  • Abdominal, chest, or pelvic pain

  • Bone pain

  • Nerve pain

  • Weakness in the limbs

  • Or various other symptoms

Bone metastases not only cause severe pain but may also lead to bone collapse, as the bone structure is weakened by tumor-related changes. Fractures are common in the vertebrae, sacrum, pelvis, humerus, and femur.

Fractures further increase pain, and patients may become bedridden and difficult to care for.

With this knowledge, therapy can be tailored according to the extent and stage of the disease, always ensuring that pain management does not interfere with oncological treatment.

It is recommended to consult a pain management specialist as early as possible—ideally at the time of diagnosis—so that pain control can be managed alongside the progression of the disease.

What Treatment Options are Available for Cancer-Related Pain?

Oncologists often begin treatment with combinations of pain medications. However, in severe cases, these may not be sufficient, or their use may be limited by side effects (such as drowsiness, nausea, constipation).

In such cases, a pain specialist can help optimize medication and apply various temporary or permanent minimally invasive procedures to treat localized pain, such as:

Nerve Block

During a nerve block, a thin needle is guided to the target nerve, and local anesthetic—often combined with a steroid—is injected to calm the nerve.

The procedure is performed under ultrasound and/or X-ray guidance and may serve both diagnostic and therapeutic purposes.

Radiofrequency Treatment

Similar to nerve block, a special needle is guided to the target nerve, and radiofrequency energy is used to permanently disrupt nerve function, thereby reducing pain.

The treating physician determines which nerves are suitable for this procedure.

Cryotherapy

Cryotherapy involves targeted freezing of a nerve using a percutaneous (through-the-skin) technique. No incision is made; a special needle is guided to the nerve.

Vertebroplasty and Other Osteoplasty Procedures

In cases of bone metastases, initial treatment is usually pharmacological, but osteoplasty is often required.

During this procedure, tumor-affected, painful, and fracture-prone bone is filled with medical cement. This stabilizes the bone and provides immediate pain relief.

Vertebroplasty is one such method used for vertebral metastases. Similar techniques can also be applied to the femur, pelvis, sacrum, and humerus.

Intrathecal Catheter and Pump

During implantation of an intrathecal catheter and drug delivery pump, a very thin (approx. 1 mm) soft catheter is placed next to the spinal cord—similar to the location used for spinal anesthesia.

Intrathecal (IT) Alcohol Neurolysis

During IT alcohol neurolysis*, sensory nerve function can be selectively blocked by administering alcohol into the spinal canal in cases of severe unilateral upper limb or chest pain.

This does not affect motor function.

Patient-Controlled Analgesia (PCA)

In patient-controlled analgesia, the patient can administer small doses of pain medication using a special device.

The medication is delivered via infusion, epidural, or intrathecal catheter. Built-in safety settings prevent overdose while allowing rapid, individualized pain relief.

Chordotomy

Chordotomy involves treating one tract of the spinal cord using radiofrequency, thereby eliminating pain and temperature sensation on the opposite side of the body.

It is recommended in cases of severe unilateral cancer-related pain and does not affect motor function.

Cancer Pain Treatment with Therapeutic Blocks and Radiofrequency

A chain of nerves runs along the front of the spine, known as the sympathetic chain. These nerves transmit pain and temperature signals between the limbs, abdomen, pelvis, spinal cord, and brain.

These nerves can be selectively “switched off” using percutaneous procedures called sympathetic nerve blocks.

Typically, treatment begins with a diagnostic block, followed—if successful—by a longer-lasting procedure, usually radiofrequency ablation.

Stellate Ganglion Block

During stellate ganglion block, local anesthetic is injected near a small group of nerves in the lower front of the neck to reduce pain in the face, chest, and same-side upper limb.

It may be used diagnostically or therapeutically. In some cases, it is also effective for upper limb lymphedema.

Splanchnic Block

Splanchnic block and neurolysis are recommended for pain associated with pancreatic and other abdominal cancers.

They can significantly reduce pain for several years, allowing reduction of other medications.

Thoracic Block

During thoracic block and radiofrequency neurolysis, a nerve center at the level of the T2–T3 vertebrae is treated.

This reduces pain in the upper limb and improves circulation. It is also recommended for lymphatic disorders and other chronic pain conditions.

Hypogastric Block and Neurolysis

Hypogastric block and neurolysis are recommended for pelvic cancer pain.

The hypogastric nerve plexus is located in front of the L5–S1 vertebrae and plays an important role in pain and temperature regulation.

Its function can be inhibited using chemical neurolysis, reducing pain if the diagnostic block is positive. Pain relief typically lasts for several years.

Ganglion Impar Block

Ganglion impar block and neurolysis are recommended for perineal, vaginal, and rectal cancer-related pain.

The ganglion impar is located in front of the lowest part of the sacrum and plays a role in pain and temperature regulation.

Radiofrequency and chemical neurolysis can inhibit its function, providing long-term pain relief—often for several years.

The range of available solutions is extensive and always tailored to the individual patient, the disease condition, ongoing oncological treatment, life expectancy, and personal preferences.

Psychological Support

Psychological support is also extremely important. Such a diagnosis places a significant emotional burden on both patients and their families, which is difficult to cope with alone.

* During chemical neurolysis, we reduce the function of nerves using alcohol or phenol. It is often applied for deactivating small nerves in cases of cancer-related pain. Generally, its effect lasts for 3 to 6 months.

Source:

  1. Zylla D, Steele G, Gupta P. A systematic review of the impact of pain on overall survival in patients with cancer. Support Care Cancer. 2017;25(5):1687–98.

  2. Smith TJ, Swainey C, Coyne PJ. Pain management, including intrathecal pumps. Curr Oncol Rep. 2004;6(4):291–6.