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These techniques can be temporary or longer lasting and range from simple options such as nerve blocks to more complex procedures such as implanted pumps. They are not suitable for everyone, but can be particularly useful for treating nerve pain or pain that is difficult to control. Your pain specialist will talk to you about the risks and benefits of each procedure they recommend.
I have an intrathecal pump, which is filled by a community nurse. I also take breakthrough medication, but some days I don’t need any. You can never tell. The pain is mysterious.
Learn more about:
- Nerve block
- Radiofrequency ablation (RFA)
- Spinal catheter with port or pump
- Spinal cord stimulator
A nerve block uses an injection of local anaesthetic to numb the nerve sending the pain signals. Sometimes an x-ray or ultrasound machine is used to help guide the needle. In most cases, the effect lasts for a few hours but it sometimes lasts for days.
A nerve block is generally used to provide short-term pain relief or to help diagnose which nerve is sending the pain signals.
This procedure can be used after a nerve block to provide longer-lasting pain relief. A pulsed RFA aims to re-educate the pain nerve to lessen the pain signal. It may take up to two months to take effect. A thermal RFA uses heat to damage the nerve.
An injection of local anaesthetic and sometimes other pain medicines near the nerves in the back. An epidural is given in hospital and the pain relief can last for up to two weeks. An epidural can also be used to see if a spinal procedure (see below) is likely to help.
If longer-term pain control is needed, a small tube (epidural catheter) may be placed a little deeper in the back. This is connected to an opening (port), which allows pain medicine to be dripped in continuously. If pain is likely to last longer than six months, the catheter is attached to a pump implanted under the skin of the abdomen (known as an intrathecal pump). This pump is refilled about every three months with pain medicine. The pump can be adjusted to provide a suitable amount of relief for your pain.
This is a long-lasting procedure to treat nerve pain problems. An electrical device is placed into the spine. It causes tingling against the nerves in the back or neck, which reduces the amount of pain felt. The procedure is done in two phases, with an initial trial phase to assess the benefit. If pain relief is above 60%, the device is permanently implanted.
This information has been developed by Cancer Council NSW on behalf of all other state and territory Cancer Councils as part of a National Cancer Information Working Group initiative. We thank the reviewers of this information: Dr Tim Hucker, Clinical Lead, Pain Service, Peter MacCallum Cancer Centre, and Lecturer, Monash University, VIC; Carole Arbuckle, 13 11 20 Consultant, Cancer Council Victoria; Anne Burke, Co-Director, Psychology, Central Adelaide Local Health Network, SA, and President Elect, The Australian Pain Society; Kathryn Collins, Co-Director, Psychology, Central Adelaide Local Health Network, SA; A/Prof Roger Goucke, Head, Department of Pain Management, Sir Charles Gairdner Hospital, Director, WA Statewide Pain Service, and Clinical A/Prof, The University of Western Australia, WA; Chris Hayward, Consumer; Prof Melanie Lovell, Senior Staff Specialist, Palliative Care, HammondCare Centre for Learning and Research, Clinical A/Prof, Sydney Medical School, and Adjunct Professor, Faculty of Health, University of Technology Sydney, NSW; Linda Magann, Clinical Nurse Consultant, Palliative Care and Peritonectomy Palliative Care, St George Hospital, NSW; Tara Redemski, Senior Physiotherapist, Gold Coast University Hospital, Southport, QLD.
Thank you to the Australian Adult Cancer Pain Management Guideline Working Party, Improving Palliative Care through Clinical Trials (ImPaCCT), and the Centre for Cardiovascular and Chronic Care (University of Technology Sydney), whose work contributed to the development of the previous editions of this booklet. Thank you also to the original writers, Dr Melanie Lovell and Prof Frances Boyle AM.
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