Page 64 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
pruritus, urinary retention, constipation, respiratory depression,
sedation and confusion. 97, level II-2

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Vertebroplasty is a percutaneous vertebral augmentation procedure
that requires an injection of cement into cancellous bone of the
vertebral body to relieve pain due to spinal compression fractures
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minimally invasive and relatively safe. It increases stability of the spine
by preventing vertebral body collapse. Patients who do not respond
to conservative therapy or are poor candidates for open surgery may
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A systematic review of seven RCTs with low risk of bias concluded
that percutaneous cement vertebroplasty or balloon kyphoplasty,
either alone or in combination with other local therapies e.g. iodine-125
seeds, chemotherapy, radiofrequency ablation or corticosteroids,
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compression fractures. The most common procedure-related AEs
was cement leakage which occurred at a rate of 24% (95% CI 11 to
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reported. 98, level I

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for large painful tumours e.g. fungating breast lesions or sarcomas
may improve pain control where analgesics and other interventions
provide suboptimal relief. Palliative surgical operations e.g. colostomy
and bypass operations may also relieve pain due to malignant bowel
obstruction. The decision for surgical intervention should be made by
a multidisciplinary team taking into consideration of other treatment
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members. 9

A systematic review found that cordotomy might be effective and safe
in mesothelioma-related pain. However, the available evidence was
limited in quantity and quality which warranted more reliable evidence
to aid decision-making on continued provision of this intervention. 99, level I

A multicentre cohort study had shown that orthopaedic oncology
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functional outcome and pain as early as two weeks post-operatively and
should be considered for impending or pathologic fracture in patients
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