Cancer pain may be due to invasion of tissues with tumor, radiation, chemotherapy damage, or metastatic fractures.  Opioids in increasing dosages may be necessary to control pain, attempting to achieve a balance between excessive sedation and pain reduction.  

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Some of the options for cancer pain include opioids (e.g. fentanyl patches, oral or rectal morphine, fentanyl spray under the tongue for immediate effect, fentora, oxycodone, hydromorphone, etc. ), anticonvulsants that help with the shooting/lancinating pain,  high dose NSAIDs or steroids to help with deep aching bone pain, antidepressants to block sodium channel conduction, marijuana and CBD oil to work on cannabinoid receptors, oral ketamine to help with nerve pain, and others. 

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Interventional options for cancer pain include more choices than are available for benign pain, including: 

1. Intrathecal infusion pumps- implanted devices that pump morphine or other potent opioids directly into the spinal fluid, and sometimes bupivicaine (a local anesthetic) and clondine (alpha 2 agonist).  The pump reduces the side effects of the opioids and other medications.

2. Chemoneurolysis-  the use of alcohol or phenol on peripheral nerves may be expanded into use in the epidural space or even the spinal fluid in severe cases that can be controlled no other way.

3. Epidural infusion pump- an external pump with an epidural catheter that exits the skin and connects to the pump.  This is frequently used for short term pain control (<3 months) whereas the intrathecal infusion pump is used more long term (>6 months).  

4. Radiofrequency ablation of peripheral and cranial nerves to reduce pain

5. Kyphoplasty is performed when there is a vertebral fracture due to metastasis

6. Radiofrequency tumor ablation in the bones is possible

7. Cordotomy is radiofrequency lesioning of some of the tracts of the spinal cord

8. Omaya reservoir- is placement of a reservoir under the scalp, with a catheter into the ventricles of the brain.  This may be used for injections of minute amounts of morphine or other opioids that have profound effects

9. Strontium treatments- a radioisotope treatment for multiple bone metastasis pain

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