Radiofrequency and cryoablation for cancer pain

Prevalence of pain in patients with cancer is high and is a feared and burdensome symptom. There has been a paradigm shift away from the World Health Organization ladder with adoption of interventional treatments early on in the treatment of cancer pain. Intentional destruction of nerves (neurolysis) with chemical (alcohol or phenol), heat (radiofrequency), or cold (cryo) are treatment modalities used to treat cancer pain. These management modalities have become both mainstays of cancer pain therapy and adjuvants to medical management. Chemical neurolysis with phenol or alcohol are commonly used for sympathetic neurolysis. Radiofrequency ablation (conventional and pulsed) and cryoablation are widely used in the treatment of nonmalignant pain. The published data on the use of theses modalities in the cancer population consist mainly of case reports. At the University of Texas MD Anderson Cancer Care Center, neuroablative techniques are frequently used to control refractory cancer pain. The evolution, histologic effect of radiofrequency and cryoablation, and their application are reviewed herein. Common clinical applications and specific techniques conducted at MD Anderson Cancer Care Center are used as examples of how these techniques can be applied to treat cancer related pain.