The role of percutaneous cordotomy for management of severe cancer pain

Background Percutaneous cervical cordotomy (PCC) is a nerve-destructive procedure for severe unilateral cancer pain related to mesothelioma and other cancers. Aims Prospective case series of patients undergoing percutaneous cordotomy for cancer pain. Methods Prospective data collection for consecutive patients who underwent percutaneous cordotomy through a joint pain/palliative care clinic at a large regional pain centre in the Northwest between 2/2008 and 6/2011. Patients were assessed 1 day prior, 2 days post procedure as well as 4 weeks postprocedure. Average and maximum pain scores on a numerical rating scale (NRS) ranging from 0 to 10 of pain 24 h prior and 48 h and 28 days post procedure, the global impression of change scale, morphine equivalent 24 h prior to and percentage reduction after procedure and side effects from procedure were recorded. Results 39 patients underwent PCS. Most common diagnoses were mesothelioma (19 patients) and bronchial carcinoma (10 patients). 29 patients had chest wall pain. Mean pain max score 24 h prior to procedure was 8.5 (SD 1.7) and 1 (SD 2.1) and 2 (SD 3.1) 48 h and 28 days post. Average pain score was 6.5 (SD 1.8), 0.85 (SD 2.1) and 1.9 (SD 2.98). Morphine equivalent dose median 140 mg prior to procedure and 50% reduction post procedure. Nine patients felt very much better, 23 patients much better on global impression of change scale 2 days post procedure. No patient had irreversible side effects from procedure. Conclusion PCS is a highly effective procedure for unilateral refractory cancer pain due to mesothelioma and other cancers in well selected palliative patients.