Project Description
Minimally Invasive Cordotomy for Refractory Cancer Pain
Approximately 30% of patients with cancer pain suffer despite
optimal medical treatment, including aggressive use of pain medication. Patients with high pain intensity scores are
at high risk for hospital readmission, interruption in cancer therapy, and
increased suffering. In these patients
with refractory cancer pain, minimally-invasive approaches to interrupt spinal
cord pain pathways can be considered.
Cordotomy is one particularly promising example which has been reported
in two series from Turkey and Egypt to improve cancer pain. However, cordotomy is rarely used in America
today, due to the paucity of clinical trial data assessing potential benefits
in a rigorous manner and ascertaining the potential risks using contemporary
neurosurgical techniques.
In our pilot clinical trial, patients with refractory cancer pain
will be randomized to undergo cordotomy (Group 1) or to continue with
comprehensive medical management (Group 2).
Appropriate candidates for cordotomy with a pain intensity ≥ 4 on a 0-10
numerical rating scale after optimal multimodal treatment will be offered
participation in this study. The primary
endpoint will be the change in pain intensity 1 week after cordotomy. Longer term assessments and complications
will also be studied.
Data from this pilot study will help determine the effect of
cordotomy on patients with refractory cancer pain. It will also help define the response of the
control group which does not undergo cordotomy.
The widely used World Health Organization (WHO) guidelines for cancer
pain management do not currently include interventional techniques such as
cordotomy. Data from this and future
carefully designed trials will be essential in determining whether
interventional techniques should be included in future WHO guidelines.
Bio
Ashwin Viswanathan, MD is an Assistant Professor of Neurosurgery whose research and clinical interests focus on the surgical management of cancer pain. He holds joint appointments with Baylor College of Medicine, MD Anderson Cancer Center, and the Houston Veterans Affairs Medical Center. Through generous support from the American Cancer Society, and in with collaboration with the Palliative Care and Pain Medicine Departments, he is studying minimally invasive cordotomy for refractory cancer pain.
Email: ashwinv@bcm.edu