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Introduction to interventional approaches for chronic pain Introduction to interventional approaches for chronic pain
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Injection therapies Injection therapies
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Peripheral injections for muscular and arthritic pain Peripheral injections for muscular and arthritic pain
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Trigger point injections Trigger point injections
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Intra-articular injections Intra-articular injections
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Botulinum toxin injection Botulinum toxin injection
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Regional administration of agents that modify neural transmission Regional administration of agents that modify neural transmission
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Peripheral nerve blocks and catheters Peripheral nerve blocks and catheters
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Spinal corticosteroid injection techniques Spinal corticosteroid injection techniques
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Neural destructive techniques: neurolytic blockade, surgical techniques Neural destructive techniques: neurolytic blockade, surgical techniques
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Chemical neurolysis: alcohol and phenol Chemical neurolysis: alcohol and phenol
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Radiofrequency (RF) techniques: RF ablation and pulsed RF treatment Radiofrequency (RF) techniques: RF ablation and pulsed RF treatment
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Sympathetic nervous system block Sympathetic nervous system block
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Coeliac plexus/splanchnic nerve block Coeliac plexus/splanchnic nerve block
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Lumbar sympathetic block Lumbar sympathetic block
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Neuraxial neurolysis: spinal neurolytic injection techniques Neuraxial neurolysis: spinal neurolytic injection techniques
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Spinal analgesics: epidural and subarachnoid Spinal analgesics: epidural and subarachnoid
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Spinal opioid administration Spinal opioid administration
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Adverse effects of spinal opioids Adverse effects of spinal opioids
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Non-opioid spinal analgesics Non-opioid spinal analgesics
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Indications for spinal analgesics in palliative care Indications for spinal analgesics in palliative care
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Technical considerations and complications in spinal drug administration Technical considerations and complications in spinal drug administration
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Neurosurgical interventions for intractable pain: intracerebroventricular opioid and neuro-destructive interventions Neurosurgical interventions for intractable pain: intracerebroventricular opioid and neuro-destructive interventions
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Miscellaneous techniques for pain control Miscellaneous techniques for pain control
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Vertebroplasty and kyphoplasty Vertebroplasty and kyphoplasty
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Spinal cord stimulation Spinal cord stimulation
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Palliative sedation: management of intractable pain when all else fails Palliative sedation: management of intractable pain when all else fails
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Conclusion Conclusion
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Additional material Additional material
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Stellate ganglion and upper thoracic sympathetic block Stellate ganglion and upper thoracic sympathetic block
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Hypogastric nerve block Hypogastric nerve block
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Ganglion impar block Ganglion impar block
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Pharmacokinetic model of spinal opioids Pharmacokinetic model of spinal opioids
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Other spinal analgesics: ketamine and midazolam Other spinal analgesics: ketamine and midazolam
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Online references Online references
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References References
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9.8 Interventional approaches for chronic pain
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Published:March 2015
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Abstract
Severe, uncontrolled pain remains common in populations with serious or life-threatening illness. Despite the availability of oral opioid therapy in most developed countries, an estimated 10-30% of people with advanced cancer have inadequate pain control. Published guidelines endorse the view that these patients should be considered for procedural, or so-called interventional, pain therapies. Generally accepted indications for interventional pain therapies include (a) uncontrolled pain despite systemic analgesics and (b) unacceptable systemic analgesic adverse effects. This chapter describes these therapies and discusses how they are best used within a multimodal strategy for symptom management. Interventional pain therapies are now incorporated into best practices for cancer pain management. These therapies, especially spinal analgesics, neurolytic coeliac plexus block, and vertebroplasty, have become essential components of palliative care, to control pain that cannot be safely and effectively managed with systemic analgesics.
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