Targeted pain treatment for face pain in mouth cancer (oral cancer)

Pain may be the initial symptom in oral cancer, and is a common complaint both in patients awaiting treatment and in those already under treatment. Pain becomes the most important problem in advanced stage of mouth cancer. Effective pain control requires more than one approach in which strong pain killer medications continue to play an essential role. Although different methods are available for giving pain medications, targeted interventional Pain relief techniques remain the principal route for pain control in the first instance. Interventional approaches include neurolysis and RF ablation of pain nerves of mouth and face, namely gasserian, glossopharyngeal and sphenopalatine.

Ganglion is a bundle of interconnected nerves that are important for pain in a certain area of the body. One such ganglion is the Gasserian ganglion or trigeminal ganglion – this ganglion is important in the treatment of pain related to all types of mouth cancer or oral cancer. Other important group of nerves are glossopharyngeal and sphenopalatine. These also need neurolysis or RF ablation for complete pain cure.

What is pain management

Pain management is a super speciality of medicine focused on reducing pain and improving quality of life through an integrative approach to care. Pain management is particularly important for cancer patients, considering almost every patient of advanced oral cancer or mouth cancer experiences severe pain.

Most of the pain associated with cancer comes from the tumor itself, by pushing on pain nerves, bones or organs, which can lead to significant discomfort. Pain also may result from common cancer treatments such as chemotherapy, radiation therapy and surgery. For example, chemotherapy may lead to peripheral neuropathy, a condition that causes tingling, numbness and weakness in the hands and arms or legs and feet.

Pain management may improve quality of life at any stage of cancer, so managing your pain is our priority. ACCN is proud to have one of the best pain management experts in the world, who cares for you throughout your treatment, to help reduce your pain and help you get comfortable.

Personalized treatment approach

The pain symptoms you experience are unique to you, which is why we tailor your pain management plan to your individual need. Pain itself may be dull, achy or sharp. It may occur frequently or once in a while or severe. The pain you experience may depend on your cancer type and stage, how much the cancer has spread, and how sensitive you are to pain (your pain tolerance). Whatever type of pain you experience, we want to treat it early to prevent it from worsening.

How quickly can I expect pain relief?

Relief is instantaneous, if the pain that you are experiencing is related only to the nerves which go to the gasserian ganglion. If neurolysis or RF ablation is performed, maximum relief starts in one to two days, and may last up to many months or more. Growth of cancer has been an important limiting factor.

Targeted pain treatment for throat pain associated with throat cancer or oral / mouth cancer.

Preparation for Interventional pain treatment

Pre treatment test – Gasserian ganglion block and other nerves block

This is usually a diagnostic step that allows us to pinpoint, more accurately, the location of the origin of your pain. Typically, numbing medicine (local anesthetic) is used to block the pain nerves that are responsible for your pain.

You might have some numbness of your face and gums, and decreased ability to chew. This might last for few hours. When the numbness resolves, your pain might return. It will be important for you to tell your interventional pain specialist doctor about your pain control, following the block.

What is a neurolytic gasserian ganglion procedure?

For the neurolytic gasserian ganglion procedure, we will use a concentrated medicated neurolytic medicine mixed with some numbing medicine. In contrast to the numbing medicine this neurolytic medicine will actually destroy the pain nerves. These selectively damaged pain nerves will not be able to let you feel the pain for a much longer time. It is very important to understand here that, this procedure does not affect the other normal roles of nerves or other nerves.

What is a Radiofrequency ablation of Pain nerves

Radiofrequency ablation of nerve or radio frequency lesion is a procedure using a specialized machine to interrupt the pain signals on a semi-permanent basis.

The basic principle of radio-frequency lesioining is placement of an insulated electrode probe, through the skin, into the target tissue or pain nerves and release RF waves.

When is the radiofrequency ablation of nerve used

Radiofrequency ablation of nerve is generally used for patients with who, all forms of commonly used pain medications are not giving satisfactorily pain relief. That means common methods of pain relief have failed.

Radiofrequency ablation of gasserian, glossopharyngeal and sphenopalatine group of pain nerves is generally advised for patients experiencing one of the below listed medical conditions:

Mouth / oral / face pain / Headache because of cancer in the mouth, tongue, teeth, oral cavity, cheek, nose, gums and base of the tongue, pharynx and throat.

In addition, to be a right candidate for radiofrequency ablation of pain nerves, you must have responded well to the test block. ie before doing an RFA procedure, numbing medicine is given in the target pain nerves and if you get more than 50% pain relief immediately, it’s an indication to proceed for the radiofrequency ablation procedure. These two steps may be done on the same day or on different days, depending upon the patient’s condition and requirement.

What is the procedure?

The radiofrequency nerve ablation uses radio waves to produce heat directed at a specific pain nerve. The heat destroys the nerve and thus relieves pain. These damaged pain nerves will not be able to let you feel the pain for a much longer time. This procedure does not affect the other normal roles of nerves.

The patient is required to lie down during the procedure

In this procedur, needle like instruments are inserted. Ultrasound (USG) or fluoroscopic (X-ray) guidance is used to correctly position each instrument, known as cannula. Once done, the radiofrequency ‘radio waves’ are directed through each cannula.

What are the benefits of Radiofrequency Ablation

• The radiofrequency ablation of pain nerves has a series of benefits as compared to the other forms of pain relief. Here we list the main benefits:
• The target nerves can be accurately controlled, thus allowing lesioning of small nerves without damaging nearby other nerves as compare to neurolysis where it is difficult to control the nerve damage accurately.
• Pain relief is rapid and usually side effects are negligible, allowing the patient to return to normal activity very soon or may be same day.
• Nerve destruction is usually long lasting and heals without any complication..
• The rate of side effects and complications is relatively low.
• When pain recurs, nerve lesion can be repeated as necessary.

How Should I Prepare for the Procedure?

The gasserian ganglion neurolysis or RF ablation is a safe medical procedure, but as with any procedure it has risks, as well as benefits. To minimize the chance of complications, we ask that you follow a few simple guidelines:

Do not eat or drink anything for six hours prior to the procedure. An exception is always made for routine scheduled medication, which you can take with a sip of water.

We ask that you be accompanied by one of the family members.

Plan on spending few hours with the interventional pain specialist. This includes time for preparation, performance of the procedure and observation period.

What Happens During the Procedure?

First, an intravenous line will be placed, generally in your hand or arm. We will initiate continuous monitoring of your vital parameters. You will be asked to lie on the treatment table. X-ray guidance will be used to help with placement of the needle like instruments and medication.

Before that patch of skin over your face will be cleaned, using an antiseptic solution, and numbing medicine injected into the skin to decrease any pain associated with performance of the procedure. The procedure takes approximately 15 to 30 minutes to perform once the monitors and X-ray machine are in place. Rarely, because the gasserian ganglion is adjacent to blood vessels, swelling or bruising of the face may occur. Should this occur, we would recommend that you rest in a seated position and use an ice pack.

What Happens After the Procedure?

After the gasserian ganglion procedure has been performed, we will continue to monitor you for approximately sixty minutes. If there are no signs of problems, you will be ready to leave. You will be provided with a set of post-procedure instructions to help guide you following the procedure.

If you have any questions after your procedure, our medical staffs are on call twenty-four hours a day, seven days a week.

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