Anesthesiology

The researches find that the Superior hypogastric plexus neurolysis (SHPN) appears to offer some relief for cancer-related pelvic pain, researchers report. Pain arising from the pelvic organs can be interrupted by a neurolytic block of the superior hypogastric plexus with alcohol or phenol. Few studies have evaluated the effectiveness of this intervention. To investigate, Dr. Dhanalakshmi Koyyalagunta and colleagues from MD Anderson Cancer Center, in Houston, Texas; examined data on 46 patients who received SHPN for pelvic cancer pain; the average follow-up duration at the first evaluation was 13.4 days.

Pain  pelvic

At the first evaluation, 22 patients (48%) had experienced an improvement in pain, with mean pain scores decreasing from 6.9/10 at baseline to 5.6/10 at follow-up (P=0.006), the researchers report in Pain Medicine, online July 25. This difference was smaller than the minimal clinically important difference of 2/10; but among patients with baseline pain scores of 7/10 or greater; but the main pain score decreased by 2.7 points (from 8.2 to 5.5).

At the second evaluation, at an average of 53.9 days, including 30 patients, pain the mean pain score had decreased from 6.9/10 at baseline to 5.3/10 at the first evaluation to 4.5/10 (P<0.0001). Therefore Factors associated with an improvement in pain score of 2/10 or greater included a baseline pain score of 7/10 or higher and nonsmoking status. All of the adverse effects in this study were very mild and well tolerated. Cancer patients can expect to suffer pain; particularly in the advanced stages of the disease.

Higher and nonsmoking status

Optimal pain control is an essential part of cancer management from the time of diagnosis, as pain can interfere with cancer therapy, limits patient function; and negatively impacts quality of life. Because Pain can result from primary solid tumors of the pelvic organs and other pelvic tissues; from metastatic tumors; or from nodal conglomerates causing mass effect. Bony pelvic tumors may extend into the pelvic cavity. Tumors of neural structures arise in the pelvis.

Pain may follow treatment of pelvic masses and other associated problems. Cancer patients may have painful conditions unrelated to their disease. Having a full understanding of the pathophysiology of pain and the ability to make a pain “diagnosis” are essential to effective pain management. One of the more challenging aspects of cancer pain management is neuropathic pain, that is; the particular type of pain related to nervous system dysfunction.

The pathophysiology of pain

Neuropathic pain may be due to mass compression or traction of nerve structures; hence which in the pelvis includes irritation of a single nerve or multiple nerves, tumor infiltration of the lumbosacral plexus in the pelvic sidewall, or a presacral mass affecting the sacral plexus. Therefore Initially, non-neural tumors will cause inflammation of nerves and nociceptive nerve pain; conditions that if not addressed will, over time, progress to nerve damage and the differentiation type of neuropathic pain. At this point in the process, pain is accompanied by neurologic deficits.