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Finding the Right Cancer Pain Relief
Cancer pain management is an important part of your treatment strategy. There are drugs, surgery, and alternative therapies, like acupuncture, that can help ease cancer bone pain.
By Chris Iliades, MD
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Cancer pain can affect all areas of your life, including sleeping, eating, and enjoying the company of loved ones. Seeking relief from cancer pain is not a sign of weakness and rarely leads to problems of addiction — and cancer pain management should be an important part of your treatment plan.
"Pain is a common symptom associated with cancer,” explains Adan Rios, MD, associate professor of medicine at the University of Texas Medical School at Houston. “Yet despite significant education efforts, pain continues to be poorly treated by many doctors. Today there are specialists such as oncologists and anesthesiologists who are more familiar with the modern management of cancer pain."
Cancer Pain Management: Types of Pain
"In general, 15 percent of patients with a localized tumor will experience cancer pain, and this number increases to around 75 percent when cancer has spread,” says Dr. Rios. “Direct tumor involvement in bone causes bone pain, and this is the situation for at least 50 percent of the patients with cancer pain."
Nerve pain can be caused by direct cancer involvement. Cancer treatment itself can cause pain — pain from surgery is common. Also, treatment with cancer drugs may cause peripheral neuropathy, which is a type of nerve pain that feels like the area is burning, tingling, or numb. Radiation treatment for cancer can cause skin burns, mouth sores, and painful swallowing.
Cancer Pain Management: Finding the Right Options
The best treatment for cancer pain is one that relieves the pain with the fewest side effects. "For over 20 years the World Health Organization had a strategy suggested for the management of pain in cancer patients," explains Rios. This strategy was based on a "ladder escalation" model of pain control that started with non-narcotic drugs and then escalated gradually to narcotic drugs called opioids. "It is now recognized that when it comes to cancer pain, opioids are the primary treatment," says Rios.
Pain management is now a specialty; most hospitals and medical centers that treat cancer pain have a pain clinic. Options for cancer pain management include pain medications, other medications, surgery, radiation, nerve blocks, and non-medical treatments.
Cancer Pain Management: Drugs
Drugs to ease cancer pain include narcotics and non-narcotics:
Non-narcotic pain medications.These over-the-counter drugs are used for the mildest forms of cancer pain and include acetaminophen and ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs).
Quick-acting opioids."Once the assessment of the severity of the pain has been established, immediate-release opioids should be the first step for moderate to severe cancer pain," says Rios. These medications may be combined with acetaminophen or an NSAID.
Long-acting opioids."As the pain is relieved, the patient can then be switched to long-acting, sustained-release opioids including oral or transdermal [skin patch] products," says Rios.
Other medications.Antidepressants and anti-convulsion drugs may be used to treat tingling or burning pain from nerve damage or nerve pain caused by cancer drugs. Steroid medications can be used to relieve bone pain or pain caused by swelling. Medications called bisphosphonates can help make bones affected by cancer stronger and help relieve cancer bone pain.
Cancer Pain Management: Cutting and Blocking Out Pain
Sometimes, it’s the scalpel, needle, or even electricity that will relieve the pain:
Radiation and surgery."At times radiation therapy or surgery can assist in the resolution of the pain crisis," advises Rios. When cancer spreads to bones, radiation therapy can be used to relieve cancer bone pain. A neurosurgeon may relieve pain by cutting nerves near the spinal cord.
Nerve blocks and spinal injections.An anesthesiologist may inject a local anesthetic into a nerve to block pain. These medications are sometimes combined with steroids to decrease swelling. Pain medication can also be directly injected into the spinal fluid or into the space around the layers of the spine, where it can numb pain in other areas of the body.
Transcutaneous electrical nerve stimulation (TENS).This treatment involves passing mild electrical currents through the skin to block pain sensation. It does not involve needles and the electrical current does not cause pain.
Cancer Pain Management: Non-Medical Treatments
There are many non-medical treatments that are used to help manage cancer pain. These techniques include relaxation, biofeedback, guided imagery, massage, and hypnosis. Another is acupuncture. This ancient Chinese therapy uses tiny needles to control pain and is now widely accepted, but should only be done by a licensed acupuncturist.
These treatments can be used alone or along with pain medications. Many health professionals such as social workers, physical therapists, and psychologists can help you learn about these techniques.
Cancer causes other types of pain, like the emotional kind. Anxiety and depression have been shown to make pain worse. Many people find that counseling from a mental health professional or the support they get from joining a cancer support group is an important part of their cancer pain management plan.
Despite all these advances and options, says Rios, there are still significant barriers to pain control in cancer patients. “These include the need for more intensive training of medical professionals in pain management and changes in social attitudes toward using opiates for pain control, including unfounded fears of addiction," he explains.
For many people with cancer, control of cancer pain is the most important part of their treatment. If your treatment team is not relieving your cancer pain, ask to see a pain specialist or to be referred to a pain clinic. Remember that you don't have to accept pain as a normal part of having cancer.
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