The potential role of peripheral nerve stimulation for focal cancer pain in hospice patients.
Poster #: 043
Session/Time: B
Author:
Casey Hadley Barry, BS
Mentor:
Matthew Chung, MD
Research Type: Case Report
Abstract
INTRODUCTION:
Effective pain management is crucial to improving quality of life in hospice patients, particularly those suffering from cancer. Numerous factors, such as mobility, transportation access, comorbid conditions, and medication interactions complicate cancer-related pain management in hospice patients, often leading to persistent, unresolved pain. Conventional pain management is guided by the World Health Organization (WHO) analgesic ladder, which espouses a stepwise approach to pharmacological and interventional therapies. The persistent experience of cancer-related pain in hospice patients, despite current modalities, underscores the urgent need for supplemental pain management strategies. Peripheral Nerve Stimulation (PNS) is a potential alternative therapy that utilizes targeted neuromodulation of affected nerves to alleviate pain. While PNS use is well-described in some chronic conditions (e.g., mononeuropathies, occipital neuralgia, and CRPS), its use in hospice patients for focal cancer-related pain is largely unexplored.
CASE INFORMATION:
This retrospective case series explores the use of PNS to treat three hospice patients with focal cancer-related pain refractory to conventional management including traditional targeted nerve blocks. Inclusion criteria included being at least 18 years of age, active enrollment in hospice for palliative care, and confirmed diagnosis of focal cancer-related pain. Temporary PNS leads were implanted percutaneously under local anesthesia, with appropriate nerve targets selected based on pain distribution. Patient monitoring was conducted at regular intervals following implantation in both inpatient/outpatient settings to assess pain intensity (NRS), quality of life (ESAS), opioid consumption (MME), and functionality.
DISCUSSION/CLINICAL FINDINGS:
Although long-term follow-up was limited by the nature of the patients' hospice status, consistent reports from patients and their families describing improved clarity of thinking and focus-attributed in part to marked reductions in pain intensity, pain-related symptoms, and overall opioid use-suggest that PNS may provide meaningful short-term palliation when appropriately selected.
CONCLUSION:
Hospice patients and their families often encounter substantial barriers to effective pain management, including stigma surrounding opioid use and limited education about alternative strategies. These obstacles can result in inadequate pain control, diminishing quality of life in a patient's final days. This case series highlights a minimally invasive option-peripheral nerve stimulation-that warrants greater awareness for managing focal cancer pain in a population often overlooked due to their hospice status. Nonetheless, careful patient selection is essential, given the relative frailty and shortened life expectancy in this group. Ideal candidates may include those for whom preserving clarity of thought is paramount, particularly when current pharmacologic regimens compromise cognitive function in the pursuit of palliation.
Effective pain management is crucial to improving quality of life in hospice patients, particularly those suffering from cancer. Numerous factors, such as mobility, transportation access, comorbid conditions, and medication interactions complicate cancer-related pain management in hospice patients, often leading to persistent, unresolved pain. Conventional pain management is guided by the World Health Organization (WHO) analgesic ladder, which espouses a stepwise approach to pharmacological and interventional therapies. The persistent experience of cancer-related pain in hospice patients, despite current modalities, underscores the urgent need for supplemental pain management strategies. Peripheral Nerve Stimulation (PNS) is a potential alternative therapy that utilizes targeted neuromodulation of affected nerves to alleviate pain. While PNS use is well-described in some chronic conditions (e.g., mononeuropathies, occipital neuralgia, and CRPS), its use in hospice patients for focal cancer-related pain is largely unexplored.
CASE INFORMATION:
This retrospective case series explores the use of PNS to treat three hospice patients with focal cancer-related pain refractory to conventional management including traditional targeted nerve blocks. Inclusion criteria included being at least 18 years of age, active enrollment in hospice for palliative care, and confirmed diagnosis of focal cancer-related pain. Temporary PNS leads were implanted percutaneously under local anesthesia, with appropriate nerve targets selected based on pain distribution. Patient monitoring was conducted at regular intervals following implantation in both inpatient/outpatient settings to assess pain intensity (NRS), quality of life (ESAS), opioid consumption (MME), and functionality.
DISCUSSION/CLINICAL FINDINGS:
Although long-term follow-up was limited by the nature of the patients' hospice status, consistent reports from patients and their families describing improved clarity of thinking and focus-attributed in part to marked reductions in pain intensity, pain-related symptoms, and overall opioid use-suggest that PNS may provide meaningful short-term palliation when appropriately selected.
CONCLUSION:
Hospice patients and their families often encounter substantial barriers to effective pain management, including stigma surrounding opioid use and limited education about alternative strategies. These obstacles can result in inadequate pain control, diminishing quality of life in a patient's final days. This case series highlights a minimally invasive option-peripheral nerve stimulation-that warrants greater awareness for managing focal cancer pain in a population often overlooked due to their hospice status. Nonetheless, careful patient selection is essential, given the relative frailty and shortened life expectancy in this group. Ideal candidates may include those for whom preserving clarity of thought is paramount, particularly when current pharmacologic regimens compromise cognitive function in the pursuit of palliation.