Cancer Pain Management in St. Louis

Cancer pain is rarely one problem. Visceral, bone, neuropathic and mechanical pain frequently coexist in the same patient, and each responds to something different. That is why the assessment decides the treatment rather than a standard menu, and why more than one approach is usually needed.

Celiac plexus block interrupts the visceral pain pathway carrying signals from the pancreas and upper abdominal organs. Its principal use is visceral abdominal pain, most commonly chronic pancreatitis. In pancreatic malignancy it has a well-established role and can substantially reduce opioid requirement.

Other sympathetic blocks target pain from pelvic and lower abdominal structures by the same principle — interrupting the visceral pathway rather than blunting perception centrally.

Vertebral augmentation — vertebroplasty and kyphoplasty — treats painful vertebral compression fractures. The great majority of compression fractures are osteoporotic; fractures caused by metastatic disease, or by bone weakened during treatment, are the less common case. The indication is the same either way: an active fracture where the pain is mechanical and load-related.

Peripheral nerve blocks address pain confined to a specific nerve distribution, including some post-surgical and post-radiation pain.

Ketamine can help where central sensitization has developed and opioid escalation has stopped producing benefit.

Not all cancer pain comes from the tumor. Chemotherapy-induced peripheral neuropathy is common, often persists after treatment ends, and is frequently accepted as permanent when it has never actually been evaluated.

We assess it as we would any neuropathy — with electrodiagnostic testing to establish what is affected and how severely, then treatment directed at the nerve and at the environment around it, including photobiomodulation where perfusion and inflammation are limiting recovery.

Post-surgical and post-radiation pain syndromes are similarly treatable and similarly under-referred.

We do not take over cancer care. Your oncologist directs treatment of the disease; we address the pain, and we communicate rather than operate in parallel.

Timing matters. Interventional options are often considered only at the very end, when a patient is least able to tolerate a procedure and the window for meaningful benefit has narrowed. A celiac plexus block performed early in pancreatic cancer does considerably more good than the same block performed in the final weeks.

If you or your physician are unsure whether an interventional option applies, that question is worth asking sooner rather than later.