Masterclass 12 - Cancer and Non-cancer Pain Management

Neuromodulation is technology that acts directly on nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area. If the electrical stimulation is applied to spinal cord. It is called spinal cord stimulation (SCS). 
This treatment option is approved by the US Food and Drug Administration (FDA) with robust evidences treating various chronic pain conditions.  It is well recommended by various international organizations, especially for the treatment of low back pain. 
Although SCS is a very common treatment modality in other countries, it is not popular in Hong Kong. Causes are multifactorial, including high initial treatment cost, under awareness of this treatment modality (not only among the patients or general population, but also among other medical specialities). However, with the support from the Hospital Authority, we developed this SCS service rapidly in last few years with structured service model and referral guidelines. The results are promising. 
In this Masterclass, I will have a review of SCS service Hong Kong especially the efficacy and cost effectiveness in our local population. It will be illustrated with clinical cases and discussion. 
Neuromodulation is life changing and a very cost effective treatment option. With the support from the Hospital Authority, I hope SCS service will develop even better, for the benefits of the patients in Hong Kong.

Up to 50% patients experienced varying degree of discomfort and pain in early stages of cancer. A significant proportion with advanced cancer have moderate to severe pain in multiple sites, with some progressing to intractable pain despite multi-modal analgesia and cancer therapy. Thus, the modified WHO analgesic ladder has incorporated pain procedures to fast track the management of severe refractory pain. However, pain intervention is not the magic bullet and does have its limitation and complications. Thus physician must assess the patient holistically and managed the family’s expectation in order to optimise the outcome. In this talk, we will explore the various regional anaesthetic block and ablative pain procedures (e.g. radiofrequency lesioning, cryotherapy, neurolysis, epidural and intrathecal therapy) that can be employed to maximize patient’s comfort.