Palliative cancer treatment in Israel: turn off the source of pain

Recent technical advances and a better understanding of the mechanisms of pain have led to the improvement of palliative cancer treatment in Israel: new surgery can turn off the source of pain in terminally ill patients.

Centers of expertise, such as the Department of Functional Neurosurgery at the Souraski Medical Center, are using neurosurgery to stop pain and suffering in patients with metastatic cancer.

Refractory pain is a serious problem that affects the quality of life.

Up to 80% of cancer patients with end-stage disease will suffer from severe pain.

The most common causes of pain:

• pressure of the tumor on the sensory nerve structures
• infiltration of tumor cells into the healthy tissues of the body
• side effects of treatment (surgery, radiotherapy, chemotherapy)

Despite the increased awareness of doctors and the improvement of protocols for the control of cancer pain, there are still patients who do not receive adequate pain management.

These people are dying suffering.

Advances in palliative cancer treatment in Israel

Our primary goal is to quickly relieve pain without side effects, so that patients can lead a normal life and continue their course of treatment. After the standard therapy failure, Israeli doctors offer high-precision neurosurgical interventions that affect pain routes inside the brain and spinal cord.

Neurosurgical approaches to pain treatment:

• procedures that destroy the pathways of pain signal transmission by neurolysis
• implantation of a intrathecal pump that releases controlled doses of opioids
• neuromodulation procedures that change the way signals are transmitted

If implants are not suitable, ablation is the most effective option. The nerve ablation is performed using a special electrode that heats the tissue with radio waves. To ensure the effectiveness of treatment and prevent side effects, there is a temperature sensor at the tip of the electrode.

Computed tomography guided radiofrequency ablation (RFA) usually results in immediate pain relief. The risk of postoperative complications is small, and recovery time is very short. The advantage of RFA in treatment of refractory cancer pain in is the absence of long-term complications associated with the implantation and maintenance of electronic devices.

Mechanisms of cancer pain 

Pain is considered a warning signal of damage to the body. This signal arises from the stimulation of pain receptors of damaged organs and tissues. These impulses are then transmitted through the thin nerve fibers to the spinal cord, and from there to the brain centers. When damaged tissue cannot be cured (for example, in malignant tumors), pain becomes the worst enemy. Then physician must treat pain aggressively to improve the patient’s quality of life. There are different methods of intervention to disrupt this pathological signal.

Among the neurosurgical approaches are the disrupting pain pathways in the spinal cord (central cordotomy or central myelotomy), as well as the disrupting pathways in the brain (cingulotomy).

Disrupting pain pathways in the spinal cord

Central cordotomy

The purpose of the surgery is to prevent the pain signals from entering the thalamus. Israeli clinics now practice O-Arm guided percutaneous radiofrequency cordotomy, using the latest American mobile surgical system from Medtronic.

In 2018, O-Arm guided percutaneous radiofrequency cordotomy is actively used by neurosurgeons at Sourasky Medical Center in Tel Aviv.

The procedure is designed to eliminate pain in the lower limbs, pelvic organs and chest. This is a minimally invasive high-precision intervention with good outcomes. There is a 10% risk of impaired motor function of the lower extremities, so radiofrequency cordotomy is reserved only for patients with advanced cancer and uncontrolled pain.

Central myelotomy

Neurosurgeons know that cutting certain nerve fibers of the spinal cord eliminates abdominal and pelvic pain of any intensity.

Such intervention is recommended for patients with metastatic tumors in the abdominal cavity, including colorectal cancer, liver tumors or stomach cancer.



Studies show that such palliative treatment provides substantial pain relief in 70% of patients. Nowadays, central myelotomy is performed using a high-precision laser or a radiofrequency electrode inserted into the spinal cord under intraoperative imaging.

Disabling pain pathways in the brain

Cingulotomy

When cancer pain comes through different nerves, it is still possible to block it at the end point of the route - our brain. For such cases, MRI-guided stereotactic cingulotomy is sometimes used. Previously popular in psychiatry, this procedure is a powerful weapon against refractory pain. Studies show that cingulotomy significantly changes the perception of chronic pain. After such an intervention, patient feels just a stimulus, but not pain.

Conclusion

The progress of Israeli oncology is accompanied by the emergence of minimally invasive, effective and safe treatments for cancer patients. In case of refractory pain, the Sourasky Medical Center and other leading hospitals of the country can offer you a simple neurosurgical solution.

Sometimes we can't beat cancer.

But we can always improve your loved one’s quality of life.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator