41. Indications for palliative radiation therapy include treatment of symptomatic metastasis in sites where tumor infiltration has caused pain, obstruction, bleeding, or compression. (B)
42. Radiopharmaceuticals emitting a B-particle should be used for the pain of bone metastasis only when bone scintigraphy shows a lesion. (A)
43. Radiation tolerance of adjacent normal tissues should be considered in the design of treatment portals and the prescription of teletherapy or radiopharmaceutical dose. (A)
44. The desired dosage of radiation should be administered in the fewest fractions possible to promote patient comfort during and after treatment.
45. Neurolytic blockade of peripheral nerves should be reserved with rare exception for instances in which other therapies (palliative radiation, TENS, pharmacotherapy) are ineffective, poorly tolerated, or clinically inappropriate. (Panel Consensus)
46. Clinicians should:
Assess thoroughly each patient's pain mechanism in order to apply the most appropriate block.
Screen patients for coexistent medical conditions, ability to understand risks of the proposed procedure, and ability to cooperate during the procedure.
Consider a block only if the person planning to do it is experienced and skillful, is prepared to deal with its immediate effects and side effects, and is able to provide follow-up assessment and treatment.
Use radiographic control for blocks when ease and safety depend on precise anatomic guidance. (Panel Consensus)
47. When a patient is painfree after neurolysis, opioids should not be stopped abruptly, lest a withdrawal syndrome be provoked. (B)
48. The oncologic surgeon should be familiar with the interactions of chemotherapy, radiation therapy, and surgical interventions so that iatrogenic complications may be avoided or anticipated. (Panel Consensus)
49. The surgeon should recognize and treat characteristic pain syndromes that follow specific surgical procedures. (Panel Consensus)
Introduction (Invasive nonpharmacologic interventions)
Radiation Therapy
Bone Metastases
Pain Relief with Localized Radiation Therapy
Nerve Blocks
Neurosurgery
Peripheral Neurectomy
Surgical Management of Pain due to Primary or Metastatic Tumor
Index