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26th Napa Pain Conference

NPC26-Sa6-B - Advances in the Management & Treatment of Cancer Pain

Aug 17, 2019 4:00pm ‐ Aug 17, 2019 5:30pm


Advances in the Management & Treatment of Cancer Pain

Target Audience: Clinicians & researchers working in oncology or treating cancer-related pain

Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Determine when to use neurolytic blocks, targeted drug delivery, and dorsal punctate myelotomy
  • Identify patients who would benefit from targeted cancer therapies
  • Provide supportive care strategies for patients with multiple comorbidities


Innovative Treatment Algorithms for Abdominal, Pelvic, Visceral Cancer Pain

David J. Copenhaver, MD

Risks/Benefits for Intrathecal Therapy Treatment Modalities

Lisa J. Stearns, MD


Visceral pain represents a major clinical problem, yet far less is known about its mechanisms compared to somatic pains, e.g. from cutaneous and muscular structures. Providers need an understanding of the neuroanatomical bases of visceral pain signaling in the peripheral and central nervous system.

Targeted drug delivery (TDD) has potential for cost savings compared with conventional medical management (CMM). Despite positive clinical and economic evidence, TDD remains underused to treat cancer pain.

Additional Reading

  • Gulati, A., Shah, R., Puttanniah, V., Hung, J. C., & Malhotra, V. (2015). A retrospective review and treatment paradigm of interventional therapies for patients suffering from intractable thoracic chest wall pain in the oncologic population. Pain Medicine, 16(4), 802-810.
  • Aiyer, R., Mehta, N., Gungor, S., & Gulati, A. (2018). A systematic review of NMDA receptor antagonists for treatment of neuropathic pain in clinical practice. The Clinical Journal of Pain, 34(5), 450-467.
  • Dai, H., Tilley, D. M., Mercedes, G., Doherty, C., Gulati, A., Mehta, N., … & Reynolds, F. M. (2018). Opiate free pain therapy using carbamazepine loaded microparticles provides up to two weeks of pain relief in a neuropathic pain model. Pain Practice.
  • Sikandar, S., & Dickenson, A. H. (2012). Visceral pain–the ins and outs, the ups and downs. Current Opinion in Supportive and Palliative Care, 6(1), 17.
  • Stearns, L. J., Hinnenthal, J. A., Hammond, K., Berryman, E., & Janjan, N. A. (2016). Health services utilization and payments in patients with cancer pain: a comparison of intrathecal drug delivery vs. Conventional medical management. Neuromodulation: Technology at the Neural Interface, 19(2), 196-205.
  • Smith, T. J., Staats, P. S., Deer, T., Stearns, L. J., Rauck, R. L., Boortz-Marx, R. L., ... & Pool, G. E. (2002). Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. Journal of Clinical Oncology, 20(19), 4040-4049.
  • Stearns, L. J., Narang, S., Albright, R. E., Hammond, K., Xia, Y., Richter, H. B., ... & Doth, A. H. (2019). Assessment of health care utilization and cost of targeted drug delivery and conventional medical management vs conventional medical management alone for patients with cancer-related pain. JAMA Network Open, 2(4), e191549-e191549.
  • Becker, R., Sure, U., & Bertalanffy, H. (1999). Punctate midline myelotomy a new approach in the management of visceral pain. Acta Neurochirurgica, 141(8), 881-883.


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