Update on pain management for advanced genitourinary cancer.

Abstract

Pain is a significant problem in many patients with genitourinary malignancy at all stages of disease. Optimal pain control becomes a primary concern as disease progresses and other therapies are exhausted. The selection of the most appropriate therapy becomes difficult without an understanding of the underlying mechanisms of pain and the available therapies. A review of the literature regarding the mechanisms and assessment of pain syndromes was performed. All available therapies were investigated with respect to conservative management with opioid medications and adjuvant drugs, and the indications for invasive techniques. Increased understanding of the mechanisms and classification of pain syndromes has led to improved assessment and treatment. Despite these advances a significant number of patients have inadequate pain control and the education of treating physicians remains an important target for improving this situation. Opioid medication is the mainstay of therapy in the majority of patients but with the appropriate addition of other adjuvant drugs patients may achieve optimal pain control without unwanted side effects. A few patients benefit from more invasive techniques, including plexus blocks and neuraxial infusion therapy, and the indications for these treatments are discussed. These therapies have largely superseded neuroablative procedures that are more destructive and associated with higher morbidity.