Head and neck nerve blocks for cancer pain management

Neurological pain relief interventional radiology procedures

Neurological interventions have taken on a significant role in interventional radiology (IR) practice. Indications fall under three main categories: (1) intraprocedural pain management, (2) cancer pain palliation, and (3) chronic non-cancer pain control. Short-term regional anaesthesia can be achieved with local anaesthetics, while longer-term pain control can be attained with radiofrequency neuromodulation (pulsed or otherwise) or thermal/chemical neurolysis. This review article summarises the therapeutic options, applications, and techniques of commonly used peripheral nerve and plexus interventions in IR.

Head and Neck Cancer-Related Pain

Pain is a common and most debilitating symptom of head and neck cancers (HNC). The prevalence of pain in HNC is nearly 70%. There are no universally accepted classification or diagnostic criteria for HNC-related pain, and currently, HNC-related pain is classified based on the underlying pathophysiological mechanism, the location of the tumor, and the protagonist of pain. The clinical presentation of HNC-related pain varies and can be similar to primary pain disorders. The management of HNC-related pain primarily consists of pharmacotherapy. However, in some cases, interventions may be needed. This article will present a case study and review the epidemiology, diagnostic criteria and classification, clinical features, pathophysiology, and HNC-related pain management.

Utilization of neurolysis in management of refractory head and neck cancer-related pain in palliative patients: A retrospective review

BACKGROUND

Pain is a common symptom of head and neck cancers. In some instances, pain may not resolve with conventional modalities and become refractory. Chemical neurolysis is a technique that utilizes chemical neurolytic agents to temporarily denervate a targeted nerve and provide relief in pain-related symptoms. The aim of this investigation was to determine the effectiveness, safety, and predictors of chemical neurolysis procedures for management of refractory head and neck cancer-related pain.

METHODS

A retrospective chart review of patients who underwent chemical neurolysis procedure in the regions of head and neck for management of head and neck cancer-related pain was conducted between November 2017 and November 2018. All adult male and female patients who had undergone chemical neurolysis procedure in the head and neck region for management of refractory head and neck related pain, in Orofacial Pain Clinic, Shaukat Khanum Memorial Cancer Hospital and Research Center were included in the investigation.

RESULTS

Among 33 participants enrolled, 72.7% of participants experienced 75% or greater relief in pain at the 1-month follow-up. However, 9.1% reported experiencing an adverse effect following neurolysis. A statistically significant association was found between neurolysis effectiveness and chronicity of pain.

CONCLUSIONS

Chemical neurolysis can provide significant relief to patients with refractory head and neck cancer-related pain as an adjunctive therapy. However, it was found to be associated with mild risk of manageable adverse effects. Shorter chronicity of pain was found to be associated with successful outcome.

Difficult problems and their solutions in patients with cancer pain of the head and neck areas

Pain management can be especially difficult in patients with head and neck cancer due to the erosive nature of the neoplasms that invade the region, the rich innervation of the head and neck, and other factors. Consequently, diagnosis is a complex process that cannot be dealt with in a cursory fashion. Furthermore, tumor pain can mimic noncancer conditions, nonmalignant orofacial disorders can be suggestive of tumor growth, and antineoplastic treatment-related conditions can be difficult to distinguish from tumor recurrence. A series of case reports illustrates key elements of diagnosis and pain management in patients with head and neck cancer. These elements include 1) detailed assessment of pain intensity and characteristics; 2) appropriate use of analgesic adjuvant medications; 3) use of diagnostic and therapeutic nerve blocks and myofascial trigger point injections; and 4) a high index of suspicion regarding tumor recurrence pain.

Characteristics of postradical neck pain syndrome: a report of 25 cases

The postradical neck pain syndrome has been briefly described in the literature, but detailed characterization has not been reported. To further define this syndrome, 25 patients with persistent pain for at least 1 month following neck dissection were evaluated. The sample consisted of 13 men and 12 women with moderate to severe pain ranging from 1 month to 27 years in duration. All patients had at least one type of neuropathic pain: spontaneous, continuous burning pain (81%), shooting pain (69%), and/or allodynia (88%). Neuropathic pain sites were within the distribution of the superficial cervical plexus (SCP). Regional myofascial pain was also common (72%). Seventeen patients agreed to undergo diagnostic local anesthetic injections. Ten of these patients had both neuropathic and somatic (myofascial) pain. Local anesthetic injection of the SCP temporarily eliminated all neuropathic pain in the 17 patients who underwent the procedure. The 10 patients who also had myofascial pain reported temporary relief of their somatic pain following myofascial trigger point injections (TPI). Criteria for the postradical neck pain syndrome are proposed: (1) persistent, nonprogressive neuropathic pain involving one or more branches of the SCP, which may be accompanied by (2) regional nonprogressive somatic pain associated with myofascial pain trigger points in head and neck muscles.