Cancer Pain
Compassionate, expert interventional pain care for patients during and after cancer treatment — with dignity, and without defaulting to opioids.
Cancer Pain is a symptom. The source is the answer.
Cancer pain is not one thing. It can come from a tumor pressing on nerve or bone, from the surgery that removed it, from chemotherapy that damaged peripheral nerves, from radiation that scarred tissue, or from the nervous system itself becoming sensitized after months of pain.
Too often, the entire response is a prescription. Opioids have a legitimate place in cancer care — but they are frequently the only tool offered, when interventional options could provide better relief with less sedation, less cognitive fog, and fewer side effects at a time when clarity and function matter enormously.
We work alongside your oncology team, not around it. Our role is to identify the specific source of your pain and treat it with the most precise tool available — so that you can live as fully as possible during treatment and beyond.
There is a persistent and quietly harmful assumption in medicine that cancer pain is simply the price of cancer — something to be endured, or medicated into the background. Both halves of that assumption deserve challenge.
Pain is not merely a symptom to be tolerated. Uncontrolled pain interferes with sleep, appetite, mobility, mood, and immune function. It reduces a patient’s ability to complete treatment. It steals the time that a patient has, whether that time is measured in decades of survivorship or in months. Treating it well is not a comfort measure at the margins of cancer care. It is part of the care.
And opioids are not the only answer. For pain arising from a specific nerve, plexus, or visceral structure, a precisely placed block can achieve relief that no oral medication matches — with less sedation, less constipation, and clearer thinking at a time when a patient’s clarity is precious.
Pain control during cancer treatment isn’t a luxury. It’s what allows a patient to tolerate treatment, to sleep, to eat, and to be present with the people who matter.
What can cause cancer pain
Below are the conditions we most commonly identify and treat. Many patients have more than one contributing source at the same time — which is precisely why careful diagnosis matters.
Tumor-Related Pain
Bone Metastases & Skeletal Pain
Tumor spread to bone produces deep, aching, often severe pain, and can cause vertebral compression fractures. Targeted interventional options can provide meaningful relief.
Tumor-Related Nerve Compression
A mass compressing a nerve root, plexus, or peripheral nerve produces neuropathic pain in that nerve’s distribution — burning, electric, radiating.
Visceral & Abdominal Pain
Pancreatic, gastrointestinal, and pelvic malignancies produce deep, diffuse visceral pain that responds remarkably well to specific sympathetic nerve blocks — an option many patients are never offered.
Vertebral Compression Fracture
Pathologic fractures from metastatic disease or treatment-related bone loss cause sudden, focal, severe back pain. They are treatable.
Treatment-Related Pain
Chemotherapy-Induced Peripheral Neuropathy
Burning, numbness, and tingling in the hands and feet caused by nerve-damaging chemotherapy agents, often persisting long after treatment ends.
Post-Surgical Pain Syndromes
Post-mastectomy, post-thoracotomy, and post-amputation pain syndromes arise from nerves injured or entrapped during surgery, and are specifically and effectively treatable.
Radiation-Induced Pain & Fibrosis
Radiation can produce fibrosis, plexopathy, and neuropathic pain in the treated field, sometimes years later.
Central Sensitization
Sustained pain during cancer treatment can amplify the nervous system’s pain processing, so that pain persists even after the disease is controlled — a survivorship issue that deserves treatment, not dismissal.
Survivorship & Whole-Person Considerations
Persistent Pain in Cancer Survivors
Pain that outlasts successful treatment. Survivors are frequently told to be grateful and to accept it. That is not acceptable care — persistent post-cancer pain is treatable.
Fatigue, Deconditioning & Movement Loss
Pain, treatment, and inactivity compound into weakness and loss of function that itself generates pain. Rehabilitation reverses this.
Sleep, Mood & Cognition
Pain destroys sleep, and poor sleep amplifies pain. Treating the whole person is inseparable from treating the pain.
Coordination With Your Oncology Team
Our care is integrated with, and communicated to, your oncologist and surgical team. Fragmented care harms patients.
What Good Cancer Pain Care Looks Like
Early Involvement, Not Last Resort
Interventional pain care is frequently offered only when everything else has failed. Earlier involvement often means better pain control at lower opioid doses, and better tolerance of cancer treatment itself.
Matching the Treatment to the Mechanism
Bone pain, neuropathic pain, and visceral pain respond to different treatments. Prescribing the same medication for all three is why so many cancer patients remain in pain despite escalating doses.
Function, Clarity & Dignity
The goal is not simply a lower number on a pain scale. It is a patient who can sleep, eat, move, think clearly, and be present with the people who matter to them.
Integrated, Not Fragmented
Pain care must be coordinated with oncology, surgery, and radiation teams. Fragmented care produces gaps, and patients fall into them.
Questions Patients Are Rarely Asked
Were You Offered Interventional Options?
Many cancer patients are never told that a celiac plexus block, an intercostal block, or a targeted ablation exists. Escalating opioid doses is not the only path, and it should not be the default one.
Are You Trading Pain for Clarity?
High opioid doses purchase pain relief at the cost of sedation and cognitive fog. For a patient whose remaining time is precious, that trade deserves to be examined rather than assumed.
Is Your Pain Being Dismissed Because You Survived?
Survivors with persistent pain are frequently told to be grateful. Post-surgical pain syndromes, chemotherapy-induced neuropathy, and central sensitization are real, identifiable, and treatable.
Is Anyone Coordinating Your Care?
Oncology, surgery, radiation, and pain management must communicate. When they don’t, patients fall through the gaps — and pain is where they land.
When cancer pain is an emergency
Seek immediate care — call 911 or go to an emergency room — for: sudden, severe back pain with leg weakness, numbness, or loss of bowel or bladder control (possible spinal cord compression, a true emergency); fever with chills during chemotherapy; sudden severe headache with confusion or vision change; difficulty breathing; or new inability to walk. Spinal cord compression requires emergency treatment to preserve function.
Diagnosis is a procedure, not a guess
Imaging alone rarely provides the answer. Findings of degeneration are extraordinarily common in people with no pain whatsoever — so an abnormal image doesn’t prove we’ve found the culprit. Conversely, some of the most treatable causes may not appear on imaging at all.
So we build the diagnosis from several converging sources:
01 — A genuinely thorough history and physical examination
Understanding the character, location, and mechanism of your pain — nociceptive, neuropathic, visceral, or mixed — determines which treatment will actually work. Our visits are longer than the industry norm because this cannot be rushed.
02 — Close coordination with your oncology team
We review imaging, pathology, and treatment plans alongside your oncologist. Interventional pain care must be integrated with cancer care, never separate from it.
03 — Correlated imaging
Imaging interpreted against your symptoms to identify the specific structure — bone, nerve, plexus, or viscera — generating pain.
04 — Diagnostic nerve blocks
Where appropriate, anesthetizing a specific nerve confirms it as the pain source and predicts whether a longer-acting or ablative treatment will help.
This is the difference between treating a picture and treating a patient. We confirm the source before committing you to a therapeutic procedure.
Precise, non-opioid, physician-performed care
Once we know the source, treatment can be targeted. Every procedure is performed personally by Dr. Joshi, using low-dose imaging, non-opioid sedation when appropriate, and hand-selected medications and products. We do not delegate procedures, and we do not use opioids as a treatment strategy.
Celiac Plexus & Splanchnic Nerve Blocks
For pancreatic and upper abdominal cancer pain, blocking or ablating the celiac plexus can provide dramatic relief and substantially reduce opioid requirements. Many patients are never told this option exists.
Superior Hypogastric & Ganglion Impar Blocks
For pelvic and perineal cancer pain, these targeted sympathetic blocks address pain that oral medication manages poorly.
Intercostal & Peripheral Nerve Blocks
For chest wall, post-thoracotomy, post-mastectomy, and rib metastasis pain — precise, image-guided, and effective.
Epidural & Nerve Root Injections
For radicular pain from tumor-related nerve compression or treatment-related nerve irritation.
Radiofrequency Ablation
For selected pain generators, ablation can provide durable relief. We use smaller-gauge needles and lower-temperature, tissue-sparing technique.
Ketamine Infusion Therapy
For neuropathic cancer pain, chemotherapy-induced neuropathy, and central sensitization, ketamine can reduce amplified pain signaling — often allowing lower opioid doses and clearer thinking.
We built the nation’s first surgery-center-based outpatient ketamine infusion program, with surgical-grade safety infrastructure — thousands of infusions delivered.
Opioid Reduction & Non-Opioid Strategy
Opioids have a legitimate role in cancer pain. But when interventional options can achieve better relief with less sedation and cognitive fog, patients deserve to be offered them. Our goal is the lowest effective opioid burden, not opioids as the default.
Dr. Joshi has never prescribed OxyContin or oxycodone in three decades of practice, and he predicted the opioid epidemic in the late 1990s. Cancer patients deserve excellent pain control — and they also deserve a physician who will exhaust the precise, non-opioid options first.
Rehabilitation, Nutrition & Whole-Person Support
Function, strength, sleep, and nutrition are inseparable from pain. Our multi-disciplinary team — including a double board-certified internal and obesity medicine physician and experienced surgical and cancer-care clinicians — supports the whole person.
Vertebral Augmentation for Compression Fractures
For painful vertebral compression fractures from metastatic disease or treatment-related bone loss, targeted procedures can provide substantial and rapid pain relief.
Sympathetic Blocks for Visceral Pain
Beyond the celiac plexus, targeted sympathetic blocks address specific visceral pain patterns that oral medication manages poorly — options many patients are never told exist.
Palliative Coordination & Survivorship Care
Whether a patient is in active treatment, in remission, or receiving palliative care, the aim is the same: the best possible function and comfort. We coordinate closely with the entire care team.
We don't rush to implant
A spinal cord stimulator is a legitimate tool for the right patient at the right time. But it’s an implant, and we treat it as a genuine last resort — not an early default reached for after a couple of quick attempts. First we find the root cause, address it, and rehabilitate it. Only when the better options are truly exhausted do we consider going there.
The same procedure is not the same procedure
Two practices can list the same procedure on a website and deliver profoundly different experiences, risks, and outcomes. Here is what changes when the details are done right.
Performed personally by Dr. Joshi
Never delegated to a technician, resident, or rotating staff. You’re treated by the physician who developed and teaches the technique — and in image-guided procedures, the difference between physicians is measured in millimeters.
Dramatically less radiation
Pulsed, low-dose imaging and a few precisely targeted spot images instead of continuous live X-ray. Based on our own procedural dose data, this reduces radiation exposure by at least 50% — and often far more — versus conventional continuous fluoroscopy, with no compromise in accuracy. For conditions treated repeatedly over years, that difference compounds.
Non-opioid sedation
When sedation is used, we use ketamine-based sedation, not fentanyl. Opioid sedation exposes you to unnecessary opioids, can complicate workplace drug testing, and can actually increase pain sensitivity. Ketamine can do the opposite.
Smaller needles, tissue-sparing lesions
Precision means we don’t need to be destructive to be effective — smaller-gauge needles and lower-temperature, longer-duration ablation that spares the healthy tissue around the target.
We actually numb you first
Thorough local anesthesia of skin and underlying tissue before the procedure begins. It takes an extra minute. We take it.
Independent, and obsessive about quality
Nearly four out of five U.S. physicians now answer to a corporate owner. We’re physician-owned, so our only incentive is your outcome. What a practice refuses to do tells you as much as what it offers.
Cancer Pain, answered
Yes, and often it should begin sooner rather than later. Nerve blocks, ablation, and infusion therapy can be performed alongside chemotherapy, radiation, or surgery — coordinated closely with your oncology team. Better pain control frequently improves a patient’s ability to tolerate treatment.
For pancreatic and upper abdominal cancer pain, a celiac plexus block can provide substantial relief while reducing opioid requirements — meaning less sedation, less constipation, and clearer thinking. It is an established option that far too many patients are never offered.
Opioids have a legitimate place here, and we do not withhold appropriate care. But they are often the only thing offered, when a targeted nerve block could provide better relief with fewer side effects. Every patient deserves to know what their options actually are.
It is common, and it is treatable. Persistent pain in survivors may reflect nerve injury from surgery or chemotherapy, radiation fibrosis, or central sensitization. Being told to simply be grateful you survived is not medical care.
Always. Interventional pain care must be integrated with your cancer care — never delivered in isolation. We communicate directly with your oncology and surgical teams.
For some patients, yes. Ketamine targets central sensitization and NMDA-receptor-mediated pain amplification that underlies much chronic neuropathic pain. We built America’s first surgery-center-based outpatient ketamine program. Individual results vary.
No. Earlier involvement generally produces better pain control at lower opioid doses and improves a patient’s ability to tolerate cancer treatment. Interventional pain care is not a last resort, though it is frequently treated as one.
No — and it frequently helps. Better pain control improves sleep, nutrition, mobility, and a patient’s ability to complete chemotherapy or radiation on schedule. We coordinate directly with your oncology team so that every treatment fits together.
That is extremely common, and it is treatable. Chemotherapy-induced neuropathy, post-surgical pain syndromes, and radiation-related pain each have specific, effective interventional approaches. Being told to simply live with it is not medical care.
Often yes, with appropriate timing and coordination — particularly attention to blood counts and infection risk. We coordinate directly with your oncology team to schedule procedures safely.
No, and this misconception causes real harm. Good pain control improves sleep, nutrition, mobility, immune function, and a patient’s ability to complete cancer treatment on schedule. It supports cancer care rather than replacing it.
Our aim is the lowest effective opioid burden through precise interventional treatment, coordinated with your oncology team. We do not abruptly withdraw necessary medication, and we do not treat opioids as the default answer when a targeted block would serve you better.
Find out what's actually causing your pain.
A precise diagnosis is the beginning of a real solution. Let’s find your pain generator — and treat it.
This page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor does it create a physician-patient relationship. Individual results vary, and no specific outcome is promised or guaranteed. Radiation-reduction figures reflect National Pain Centers’ own procedural dose data compared with conventional continuous-fluoroscopy technique. Certain regenerative therapies are considered emerging or investigational and are not FDA-approved for all uses. Always consult a qualified physician regarding your medical condition. If you are experiencing a medical emergency, call 911.