Trends in pain relief and the role of interventional radiology

In order to orientate readers to the context of care in which interventional radiology has an important place in pain management, a brief history of the approach to analgesia is presented with a focus on cancer pain. The difficulty in establishing a modern evidence base in an ethically challenging area of medicine is discussed. The pendulum of public opinion about opioid and cannabinoid medicines for pain in the context of recreational drug use and substance use disorders is presented. The lack of direct relationship between opioid analgesic prescribing and the suffering caused by poisoning of the recreational drug supply is emphasised. The three primary contexts where interventional radiology has a role in analgesia are described: to minimise the use of opioids and other analgesics; when opioids and other analgesics are not working; and when access to analgesics is restricted. The practical aspects of delivery of interventional radiological palliative procedures are discussed, particularly the vital collaboration and coordination between services needed to ensure success, and the need for interventional radiologists to ensure that post-procedural care is provided safely, particularly the tapering of opioids, which requires focused training and support. The need to consider the patient's situation and goals of care when developing a treatment plan are emphasised and illustrated.