Sleep disturbance is a major cause of depression, functional impairment and can cause disruption of life. Neural blockade is one of the diagnostic tools frequently used. It is also a tool for therapy as well as prognosis prior to the neurolytic procedure. Understanding the indications for neural blockade is as important as interpreting the result obtained from the procedure. Once the diagnosis is established, a therapeutic plan can be formulated.
Medical therapy is usually the initial management for both cancer and non-cancer pain.
However, one should bear in mind the limitation of medical modality. Other analgesics include antidepressants, anxiolytics, anticonvulsants, local anesthetics, adrenergic agents and antihypertensive agents. Use of narcotics in non-cancer patient is controversial. In my opinion, with appropriate justification, establishment of narcotic contract with the patient, careful observation of the patient's behavior and frequent monitor of prescription, narcotics should not be deprived from this group of patients. In fact, while physical dependency is unavoidable, additcion behavior or psychological dependency is rare.