About one-third of patients being treated for cancer experience pain, which can take many forms. It may be short-lived or long-lasting, mild or severe, or affect one or a few organs, bones or organ systems. Since each patient’s pain is unique, cancer pain management treatment plans must be tailored to address individual needs.
Not everyone with cancer experiences cancer pain, but 1 out of 3 people undergoing cancer treatment does. If you have advanced cancer — cancer that has spread or recurred — your chance of experiencing cancer pain is even higher.
Cancer pain occurs in many ways. Your pain may be dull, achy or sharp. It could be constant, intermittent, mild, moderate or severe. Our Pain Management Specialists at Hospital Angeles Tijuana, offer some insight into cancer pain, reasons why people might not get the pain treatment they need and what they can do about it.
Cancer pain has different ways to manifest, its considered a “dynamic pain”, because it is in constant change, it could be neuropathic pain or somatic pain or even could be a combination of both. This explains why high doses of morphine, Oxicodone, Hydrocodone or Hydromorphone (Opioid) sometimes don’t heal the pain away, because these drugs are meant to treat somatic pain only, they do not improve neuropathic pain. To achieve this we must diagnose the specific pain syndrome in order to address the proper medication program, based on a scheduled fashion or manner.
It is commonly suggested for neuropathic pain to use anticonvulsive drugs, antidepressants or other types of drugs that aren’t opioid in order to penetrate neural tissues that are or could be damaged, and therefore originating neuropathic pain.
A few examples of somatic pain in Cancer pain is bone cancer or bone invasion. Somatic pain could have a variable or a subtype, the Visceral pain; in this case pain is originated by a specific organ, such as liver, stomach, pancreas or bowels. During this pain type, it is recommended to be extremely precaution with Opioid and its derivatives, because this drug type could compromise the bowel movements and therefore increase the risk of constipation, nausea and vomit, although they are proven to provide excellent analgesia.
This is a reason why during Visceral pain, the treatment must be combined with different types of analgesic drugs (antispasmodics), in this way we are addressing the treatment not just only to decrease the pain, but to decrease the spasm or colic that is the pathophysiological cause, hence pain improvement. A few examples of Visceral pain during cancer are colon cancer, gastric cancer, pancreatic cancer or liver cancer.
When the patient is considered a candidate we offer time prolonged nerve blocks to gain a better pain control during cancer. These procedures are performed in a special area that has all the safety requirements such as an operating room, X-ray area or emergency area, such as X-ray, CAT scan or Fluoroscopy guided, meaning that risks of failing decrease considerably.
We consider a Cancer Patient as a very special person and patient, because we are not only treating a sick organ or part of the human body, we are treating a very complex and integrated universe (Human being) that has emotions, worries, that could suffer from sorrow or depression or even be angry with life or with his or her religious believes, therefore originating domestic hard times or difficult situations that require guidance through the primary care family member.
It is known that the patient is the one that has the cancer or caries a terminal illness, but it’s not the only one that suffers from it, the ones or the loved ones that surround the patient are involved to, therefore Palliative Care must be the primary objective of the Pain Specialist, to help or assist the patient during this part of his or her life, and give guidance to the family members on how to go by all of the difficult and challenging situations that they are going to confront.
Pain from the tumor: Most cancer pain occurs when a tumor presses on bone, nerves or organs. The pain may vary according to location. For example, a small tumor located near a nerve or the spinal cord may be very painful, while a larger tumor elsewhere may not cause discomfort.
Treatment-related pain: Chemotherapy, radiotherapy and surgery can cause pain. Also, certain painful conditions are more likely to occur in patients with a suppressed immune system, which often results from these therapies.
Post-operative pain: Acute, short-term pain resulting from surgery. Relieving post-op pain helps people recuperate from surgery more quickly and heal more effectively.
Cancer pain is very treatable. About nine out of 10 cancer pain patients will find relief using a combination of medications. Many medicines are used for cancer pain management. Some drugs are general pain relievers, while others target specific types of pain. Most pain drugs require a prescription.
Non-opioids: Examples are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Most non-opioids can be purchased over-the-counter without a prescription.
Opioids: Examples are morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl and methadone.
Antidepressants: Examples are amitriptyline, imipramine, doxepin and trazodone. Taking an antidepressant does not mean that you are depressed or have a mental illness.
Antiepileptics: Examples include gabapentin. Taking an antiepileptic does not mean that you are going to have seizures.
Steroids: Examples are prednisone and dexamethasone.
Some patients have pain that is not relieved by medicine. In these cases the following treatments for cancer pain management can be used to reduce pain:
Radiation therapy: This treatment reduces pain by shrinking a tumor. A single dose of radiation may be effective for some people.
Nerve blocks/implanted pump: Certain nerve blocks, temporary or permanent, may help relieve some painful conditions. Implanted pain pumps can also provide relief in some patients.
Neurosurgery: nerves (usually in the spinal cord) are cut to relieve the pain.
Surgery: When a tumor is pressing on nerves or other body parts, operations to remove all or part of the tumor can relieve pain.