Qudsia Anjum.
Role of Neuromodulation in the treatment of Opioid poorly responsive Cancer pain.
J Coll Physicians Surg Pak Jan ;12(3):189-94.

Some pain syndromes may be difficult to treat due to poor opioid response. In this situation a range of alternative measures is used; including adjuvant drugs with independent effects, like NSAIDs, anti depressants, sodium channel blockers and Entonox; drugs used to reduce opioid side effects e.g. benzodiazepines, haloperidol; or those that enhance opioid analgesia, e.g. ketamine. In 10% patients who still do not respond to WHO 3-step ladder pattern treatment we suggest neuromodulation, i.e. 4-step ladder-pattern use of regional anesthetic blocks to relieve cancer pain.

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