Procedures Used to Control Specific Types of Cancer Pain| Type of procedure | Most common indications |
| Anesthetic |
| Inhalation therapy with nitrous oxide | Breakthrough pain, incidental pain in patients with diffuse, poorly controlled pain |
| Intravenous barbiturates (for example, sodium pentobarbital) | Diffuse body pain and suffering inadequately controlled by systemic opioids |
| Local anesthetic by intravenous, subcutaneous, or transdermal application | Neuropathic pain in any site with local application to the area of hyperesthesia or allodynia |
| Trigger point injections | Focal muscle pain |
| Nerve block |
| Peripheral | Pain in discrete dermatomes in chest and abdomen or in distal extremities |
| Epidural | Unilateral lumbar or sacral painSFTRETMidline perineal painSFTRETBilateral lumbosacral pain |
| Intrathecal | Midline perineal painSFTRETBilateral lumbosacral pain |
| Autonomic |
| Stellate ganglion | Reflex sympathetic dystrophy |
| Lumbar sympathetic | Reflex sympathetic dystrophy of the lower extremitiesSFTRETLumbosacral plexopathySFTRETVascular insufficiency of lower extremity |
| Celiac plexus | Midabdominal pain from tumor infiltration |
| Intermittent or continuous epidural infusion with local anesthetics | Unilateral and bilateral lumbosacral painSFTRETMidline perineal painSFTRETNeuropathic pain from the midthoracic region down |
| Intermittent or continuous epidural or intrathecal with local opioid analgesics | Unilateral and bilateral pain below the midthoracic region; often combined with local anesthetics |
| Intermittent or continuous intraventrical infusions with opioid analgesics | Head and neck pain and upper chest |
| Chemical hypophysectomy | Diffuse bone pain |
| Neuroablative |
| Nerve root: rhizotomy | Somatic and neuropathic pain from tumor infiltration of the cranial and intercostal nerves |
| Spinal cord: dorsal root entry zone lesion | Unilateral neuropathic pain from brachial, intercostal, and lumbosacral plexopathy and postherpetic neuralgia |
| Spinal cord: cordotomy | Unilateral pain below the waist; often combined with local neurolytic blocks in perineal and bilateral lumbosacral plexopathy; may be performed bilaterally |
| Spinal cord: myelotomy | Midline pain below the waist, but rarely used because it involves extensive surgery |
| Brain stem: mesencephalic tractomy | Pain in the nasopharynx and trigeminal region |
| Thalamus: thalamotomy | Unilateral neuropathic pain in the chest and lower extremity |
| Cortex: cingulotomy | Useful through a stereotactic approach for diffuse pain |
| Pituitary: transsphenoidal hypophysectomy | Bone metastases in endocrine-dependent tumors, breast, and prostate |
| Neurostimulatory |
| Peripheral nerve: transcutaneous and percutaneous electrical nerve stimulation | Dysesthesias from tumor infiltration of nerve or trauma |
| Spinal cord: dorsal column stimulation | Of limited use in neuropathic pain in the chest, midline, and lower extremities |
| Thalamus: thalamic stimulation | Of rare use in neuropathic pain in the chest, midline, or lower extremity |
| Radiotherapy |
| External beam | Bone and brain metastasesSFTRETNerve and spinal cord compression |
| Physical |
| Cutaneous stimulation (superficial heat, cold, massage) | Dysesthesias from tumor infiltration of nerve or trauma |
| Transcutaneous electrical nerve stimulation | Cutaneous nerve injury pain |
| Acupuncture | For focal or diffuse pain syndrome |
| Bed rest | Reduced movement-related pain syndrome |
| Psychological |
| Hypnosis | Provides distraction and cognitive approach to reduce pain |
| Relaxation, imagery, biofeedback, distraction, reframingSFTRETPatient education | Provides distraction and cognitive approach to reduce pain |
