Cancer pain arises from multiple simultaneous mechanisms: direct tumour compression of nerves and organs; tissue erosion by infiltrating cancer cells; spread to distant organs (bone, liver, lung metastases); damage from chemotherapy (peripheral neuropathy); radiation-induced tissue injury and fibrosis; and pain from surgical removal of infiltrated structures. The severity arises because multiple pain types nociceptive, inflammatory, and neuropathic fire simultaneously, overwhelming simple analgesic approaches.

India consumes less than 1% of the world’s medical morphine despite bearing nearly 8% of global cancer deaths. The reasons are multiple: cultural fear of opioids and belief that morphine signals “the end”; regulatory barriers to prescribing; patients bypassing pain specialists and remaining under oncology follow-up alone; lack of specialist pain services outside major cities; and insufficient awareness both among patients and healthcare providers that effective interventional alternatives exist. IBAP Clinics exists to change this for patients in Hyderabad and beyond.

A neurolytic coeliac plexus block injects absolute alcohol or phenol around the coeliac plexus the nerve network near the aorta that relays upper abdominal pain under fluoroscopic or CT guidance. It provides significant pain relief in 70–90% of patients with pancreatic cancer, gastric cancer, liver metastases, and cholangiocarcinoma. Most patients experience relief within 24–48 hours, dramatically reducing opioid requirements, often allowing patients who had stopped eating to resume nutrition and re-engage with their oncological treatment.

Both systems deliver analgesic medications close to the spinal cord via a catheter, bypassing the systemic circulation and dramatically reducing required drug doses. The epidural catheter sits outside the dural sac, delivering local anaesthetic and opioid into the epidural space  excellent coverage for thoracic, abdominal, and pelvic pain. The intrathecal catheter penetrates into the CSF surrounding the cord itself, delivering drugs at approximately 300× greater potency than the oral route. Both can be connected to external infusion pumps for home use  a practical and cost-accessible approach that IBAP Clinics specialises in for Indian patients for whom a surgically implanted pump is not feasible.

Yes — and this coordinated approach is increasingly the gold standard. Radiotherapy is typically delivered first to shrink the tumour and devitalise cancer cells within the vertebra. Once RT is complete and the response is confirmed, kyphoplasty provides cement augmentation into the treated vertebral body, securing the bone against collapse and providing immediate, dramatic pain relief. This sequence provides both anti-tumour and mechanical pain benefits. In cases of impending fracture, the sequence may be adjusted a decision made jointly between the interventional pain specialist and radiation oncologist. At IBAP Clinics, we coordinate this directly with oncology colleagues.

Profoundly. Patients in severe uncontrolled pain frequently decline further chemotherapy, miss radiotherapy appointments, or refuse surgery  not because the cancer has beaten them, but because the pain has. Families watching a loved one suffer daily begin to question whether continued treatment is kind, sometimes becoming advocates for stopping treatment. Depression almost universal in poorly controlled cancer pain chemically suppresses motivation and the capacity to imagine a better future. At IBAP Clinics, we have seen patients who had “given up” resume treatment and re-engage with life following successful pain intervention. Pain management is what makes cancer treatment possible.

Ketamine is available and used in India at IBAP Clinics as a supervised intravenous infusion for opioid-refractory cancer pain and opioid-induced hyperalgesia  often with remarkable results for patients who have not responded to standard analgesics. Cannabis-based medicines are available in some forms in India; the regulatory landscape is evolving. At IBAP Clinics, we discuss all available and emerging therapeutic options transparently, including realistic assessment of access, cost, and expected benefit for each individual patient.