Cancer and Pain

Cancer pain  is one of the most common symptoms among the cancer patients. It is of vital importance to provide adequate pain relief so that cancer patient can live the last stages of their life comfortable & happily. There are various nerve block techniques used by pain specialist at our Impulse Pain Clinic to achieve this goal.

What causes pain in people with cancer?
Pain is most often caused by the cancer itself by stretching or damaging organ.  But pain can also be caused by the surgery, post operative or in patient had advanced cancer taking  chemotherapy.

  • Cancer pain can almost always be relieved or lessened.
  • Treat Early-Pain Relief is Every Patient’s Right
  • If you follow doctors orders – you will never get addiction to medicines

Pain from cancer
Whether you have pain and the amount of pain you have depends on the type of cancer, its stage (extent), and your pain threshold (tolerance for pain). Most of the pain occurs when a tumor presses on bones, nerves, or body organs. People with advanced cancer are more likely to have pain.

Spinal Cord Compression
When a tumor spreads to the spine, it can press on the spinal cord. This is called spinal cord compression. THIS IS RED FLAG SIGN – CONTACT DOCTOR URGENTLY. This compression must be treated quickly to keep you from losing control of your bladder or bowel or being paralyzed.

Bone pain
This type of pain can happen when cancer spreads to the bones.  You may still need opioids or other pain medicines, but sometimes these treatments can greatly reduce your pain.

Surgical pain
Surgery is often used to treat cancers that grow as solid tumors, but other treatments such as radiation or chemotherapy may also be given. Depending on the kind of surgery you have, some amount of pain is usually expected.  Pain due to surgery can last from a few days to a few weeks, depending on the type of surgery.

Pain from other cancer treatments
Some of the side effects that occur with chemotherapy and radiation treatments may cause pain for some people. Some complications are as follows

  • Peripheral NeuropathyThis condition refers to pain, burning, tingling, numbness, weakness, clumsiness, trouble walking, or unusual sensations in the hands and arms or legs and feet. Peripheral neuropathy can be caused by certain types of chemotherapy, though vitamin deficiencies, the cancer, and other problems can also cause it.
  • Mouth sores (stomatitis or mucositis)Chemotherapy can cause sores and pain in the mouth and throat. The pain can be bad enough that people have trouble eating, drinking, and even talking.
  • Radiation mucositis and other radiation injuriesPain from external beam radiation depends on the part of the body that’s treated. It can cause skin burns, mucositis (mouth sores), and scarring – all of which can result in pain. The throat, intestine, and bladder are also prone to radiation injury, and you may have pain if these areas are treated.

Treating cancer pain
Your doctor will want to find out more about what’s causing your pain. Drugs, procedures, cancer treatments, or even surgeries may be used in special ways to manage your pain. The goal is an effective pain control plan that works for you. For treatment we follow WHO ladder of analgesics.
For some conditions, medicines and non-medical treatments may not work well. But there are special pain treatments that can often be used for these kinds of cancer pain. For instance, doctors may use things like

  • Surgery to remove all or part of the tumor
  • Nerve blocks, in which medicine is injected into or around a nerve or into the spine to block the pain
  • Neurosurgery, where nerves are cut to relieve the pain

Measurement of Pain
There are many pain score used worldwide. we usually using a ” Numerical Rating Scale “ which is helpful in describing how much pain you’re feeling. To use the Pain Intensity Scale below, try to assign a number from 0 to 10 to your pain level. If you have no pain, use a 0. As the numbers get higher, they stand for pain that’s getting worse. 10 means the worst pain you can imagine.

Management of Pain by WHO ladder

FIRST LADDER :  ( NON OPIODS & ADJUVANTS )
It contains many drugs include NSAID, Anti depressents, Anti convulsants, Anti spasmodics, Sedatives, Muscle relaxants, Bisphosphonates, steroids etc. Some people have problems that NSAIDs may make worse.
In general, NSAIDs  ( Routein Pain Killer drugs ) should be avoided by people who

  • Are allergic to aspirin or any other NSAIDs
  • Are on chemotherapy
  • Are taking steroids
  • Have stomach ulcers or a history of ulcers or bleeding disorder
  • Have Diabetes or kidney problem
  • Are taking blood-thinning medicine
  • Are taking lithium

SECOND LADDER ( WEAK OPIODS & ADJUVANTS )
Weak opiods include Tramadol, Tependalol, codine for reduction of pain. This weak opiods given along with adjuvants medicine like described above.

THIRD LADDER( STRONG OPIODS )
Opioids are much like natural substances (called endorphins) made by the body to control pain. Some work better than others in relieving severe pain. These medicines were once made from the opium poppy, but today many are synthetic, that is, they are made by drug companies. This drugs are Morphine, Fentanyl or Buprenorphine.
To get good pain relief it should be taken as prescribed and doses should not be omitted thinking that I will take when pain will start.
Some of the side effects of opioids are drowsiness, nausea and vomiting, itching and constipation. Usually these reduce in few days after starting opioids. Many side effects can be controllable with adjuvant medicine.

FORTH LADDER ( INTERVENTIONAL PROCEDURES )

Nerve block
A nerve block is a procedure where a local anesthetic, often combined with a steroid, is injected into or around a nerve or into the space around the spinal cord to block pain for short duration of analgesia.
For longer-lasting pain relief, phenol or alcohol can be injected. RF ( Radiofrequency ) nerve ablation also a good technique for prolong nerve block.
Nerve block given according to the region of body where cancer causes pain.

Spinal analgesia
Low doses of pain medicine may be injected into the fluid around the spine (called intrathecal injection). If this works, a tube and a pump may be used to deliver the pain medicine right into the spinal fluid to control the pain. Morphine is often used for this purpose, and you can still have side effects like itching and constipation. Procedure is done to put the small pump and tube into your body. It’s called “Intrathecal Implantable Pump”

Epidural Injection
Certain kinds of pain may respond to pain medicine that’s injected into the space around the layers of the spine. If this works, a pump can be implanted so that you can get pain medicines right around the nerves. This may cause numbness or weakness of the treated area.

More cancer treatment may be given to shrink the tumor.
Sometimes, even when cancer treatment cannot cure the cancer, it can shrink the size of a tumor that’s pressing on nerves and organs and causing pain. Chemo, hormone therapy, or radiation may be used in this way. Radioactive injections are sometimes used when the cancer has spread to many places in the bone – the radioactive drug settles in the bones near the cancer and helps to stop its growth and relieve pain. In a few cases, other treatments like radiofrequency ablation can be used in certain areas of the body. In this treatment, electrodes are put in near the tumor to heat and destroy the cancer.

Non-medical treatments for pain
Non-medical treatments are now widely used to help manage cancer pain. Many techniques are used along with pain medicine, though they can also be used alone for mild pain or discomfort. Some people find they can take a lower dose of pain medicine when they also use non-medical treatments. These methods include: relaxation, biofeedback, imagery, distraction, hypnosis, skin stimulation, Transcutaneous electric nerve stimulation (TENS), acupuncture, exercise or physical therapy, and emotional support and counselling.