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(L) Dr. Jee Youn Moon – Cancer Pain and Neuromodulation – Video Hero Slider

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Cancer Pain and Neuromodulation

Dr. Jee Youn Moon from Seoul discusses neuromodulation therapy for cancer pain, emphasizing the importance of correct indication and timing. Neuropathic cancer pain—caused by tumor progression, chemotherapy, or radiation—is prevalent, affecting up to 50% of patients. Evidence supports spinal cord stimulation (SCS), DRG stimulation, and peripheral nerve stimulation (PNS) for refractory neuropathic pain, especially in cancer survivors. Neuromodulation should be considered earlier in treatment, even before high-dose opioids, to improve outcomes, reduce opioid use, and enhance quality of life. Alternative modalities like scrambler therapy, electroacupuncture, and sympathetic blocks with botulinum toxin also show promise. Earlier intervention, individualized care, and multimodal strategies are essential.

Percutaneous Lumbar Decompression

This talk highlights the effectiveness and underutilization of the MILD procedure—now formally known as Percutaneous Interlaminar Lumbar Decompression—in treating lumbar spinal stenosis with neurogenic claudication. With over 110,000 cases and 88% satisfaction, it offers a non-implant, minimally invasive solution targeting the root cause: hypertrophic ligamentum flavum. Dr. Stanley Golovac explains patient identification, imaging, clinical criteria, procedural tools, and outcomes, advocating its earlier use before spacers or surgery. Emphasis is placed on diagnosing correctly, proper coding, anatomy respect during the procedure, and debulking the ligament for significant functional improvement—especially in aging populations.

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Visceral Neurolytic Blocks for Cancer Pain

This presentation addresses cancer-related abdominal and pelvic pain management through interventional procedures targeting sympathetic pathways. Dr. Ale reviews indications for splenic nerve neurolysis and celiac plexus block, especially for upper abdominal malignancies like pancreatic cancer. Current evidence supports these blocks (graded 2B+) for opioid-sparing analgesia, though high-quality studies are limited. Advances include CT-guided and endoscopic approaches, and adjunct use of agents like dexmedetomidine to enhance outcomes. The talk also covers superior hypogastric plexus neurolysis for refractory pelvic pain, detailing approaches, complications, and preventive measures. Emphasis is placed on early integration of these procedures and the need for better evidence to improve cancer pain care.

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This panel discussion brings together leaders from numerous pain and neuromodulation societies worldwide to address fragmentation within the field. The conversation highlights the diversity of missions among societies like AAPM, INS, WIP, NANS, LAPS, and various state-level organizations. Each group shares its unique focus—whether it’s global education, advocacy, innovation, or specialized therapy. The panelists explore challenges in coordination, competition for resources, and diluted political voice. Despite differences, there's consensus on the need for collaboration to improve patient care and influence policy. Ideas include shared goals, joint advocacy, educational alignment, and possibly forming coalitions like radiology’s RADPAC model.

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Society Panel: Discussing the importance of societies

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Intrathecal Drug Delivery Novel Dosing Parameters

This presentation focuses on precision targeted drug delivery (TDD) for cancer pain management, emphasizing recent advances in dosing strategies and intrathecal pharmacology. Dr. Hermant Kalia highlights three core pillars for improved outcomes: infusion settings, drug chemistry, and CSF flow dynamics. The updated 2024 PACC guidelines provide structured recommendations for medication selection, catheter tip placement, and patient-specific factors, stressing system-based considerations like refill logistics. Zyconotide, initially challenged by side effects, now benefits from innovative approaches such as scheduled or patient-controlled boluses, reduced concentrations, and higher infusion rates to maintain efficacy while minimizing toxicity. Precision TDD is evolving toward individualized, guideline-driven, and optimized dosing paradigms.

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Cancer Pain and Neuromodulation

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Percutaneous Lumbar Decompression

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This presentation addresses cancer-related abdominal and pelvic pain managementthrough interventional procedures targeting sympathetic pathways. Dr. Ale reviews indications for splenic nerve neurolysis and celiac plexus block, especially for upper abdominal malignancies like pancreatic cancer. Current evidence supports these blocks (graded 2B+) for opioid-sparing analgesia, though high-quality studies are limited. Advances include CT-guided and endoscopic approaches, and adjunct use of agents like dexmedetomidine to enhance outcomes. The talk also covers superior hypogastric plexus neurolysis for refractory pelvic pain, detailing approaches, complications, and preventive measures. Emphasis is placed on early integration of these procedures and the need for better evidence to improve cancer pain care.

Visceral Neurolytic Blocks for Cancer Pain

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Society Panel:
Discussing the importance of societies

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Intrathecal Drug Delivery Novel Dosing Parameters

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Ashish Shetty

September 1, 2016

Neurolysis in the United Kingdom

Dr. Ashish Shetty talks about his positive experience of working with Dr. Gabor Racz. He gives his professional opinion of the evolution of pain management in the United Kingdom.

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Neurolysis in the United Kingdom

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