FIRST AND FOREMOST, ONE SHOULD NOT SUFFER WITH SEVERE CANCER PAIN
WHICH IS UNDERTREATED FOR FEAR OF ADDICTION OR SOCIAL STIGMA
ATTACHED TO THE USED OF MEDICATIONS.
Cancer is a dreaded word which in the past meant a horrific painful death. Now
cancer treatments may more reliably bring cancer into remission or even cure in some
instances with a much longer life expectancy than only a few decades ago. Yet,
cancer can be painful due to the disease itself (such as pressure of the tumor on body
organs, bones, nerves or invasion of these structures such as the spinal canal or
blood vessels) and also due to the treatments of cancer pain. There are a variety of
treatments for cancer and some of them are less than pleasant. However not all
people being treated for cancer experience ALL of the array of side effects of these
treatments. A side effect one person feels may never happen to another. It is also
very important to remember that many treatment-related side effects can be
successfully prevented in some cases, and treated if they occur. More information
about managing side effects is explained where each treatment type is discussed.
Some examples of treatment-related pain include:
• Chemotherapy can cause numerous side effects, depending in the medication being
used. Some of the more common side effects that cause pain include mouth sores
(mucositis), peripheral neuropathy (numb and sometimes painful sensations in the
feet, legs, fingers, hands and arms), constipation, diarrhea, nausea, vomiting and
abdominal cramps. Some people also experience bone and joint pain from
chemotherapy medications and from some medications used to offset the impact of
the chemotherapy on blood counts and on the risk of infection.
• Surgical treatments will, in some instances produce pain after they are completed.
Your physician and nurse will provide medications and techniques to help you manage
surgery-related pain.
• Procedures related to cancer pain, such as biopsies, blood draws, lumbar
punctures, laser treatments, etc. can cause pain.
TREATMENTS: Treatment of cancer related pain is dependent on the source.
Pancreatic cancer often responds to celiac neurolytic plexus blocks which provide 3-6
months worth of relief. Bone metastasis pain often responds to indocin or other
powerful NSAIDS or strontium radiotherapy. More recently, bone liver and kidney
metastasis pain have been treated effectively with radiofrequency ablation or
cryoablation. Neuropathic burning pain due to compression or invasion of nerves may
respond to anticonvulsant therapy, lidocaine IV infusions, or plexus catheter
placements. The patient with diffuse pain often responds to oral narcotics or
transdermal narcotic patches. If the pain is too severe for this, fentanyl lozenges are
used as breakthrough pain. For patients in whom oral narcotics or transdermal
narcotics are no longer effective or are fraught with severe side effects, intrathecal
infusion pump implantation or tunneled epidural catheters are very effective for pain
control. One study demonstrates a longer survival rate in those who have implantable
intrathecal pumps and certainly the costs of medications are reduced significantly.
Other neuroablative techniques may be used in severe cases. www.cancer-pain.org
