Cancer Pain Treatment Is Complex
CancerWise - June 2008
By Dawn Dorsey
Cancer pain is seldom simple, and it defies a one-size-fits-all solution. Solving the puzzle often requires employing a variety of methods to treat layers of physical and mental causes and aggravating factors.
“Chronic pain is so all-encompassing,” says Allen Burton, M.D., professor and clinical medical director of M. D. Anderson’s Pain Management Center.
“It may begin as an irritating problem and build over time until it ripples into the patient’s psychological makeup, causing him or her to become depressed or anxious. It also may have an impact on functionality, preventing the patient from performing to previous levels or doing things like walking, enjoying family or holding a job.”
The significant impact of pain makes it important for cancer patients to be aware of their symptoms and take action, Burton says. They should find a pain management specialist in their area and get assessed and treated as soon as possible.
Accurate diagnosis is important
Intricate layers of care are required to assess and treat cancer-related pain.
M. D. Anderson’s center uses a multidisciplinary approach, drawing on the expertise of specialists in anesthesiology-pain medicine, physical medicine and rehabilitation, neurology, psychology and other fields.
The first step in assessing patients is a complete health history and physical examination. Generally, this provides enough information to know what is causing the pain.
Pain might be caused by:
- Cancer treatment
- An unrelated, perhaps pre-existing, factor
Sometimes additional tests, such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans may be needed to pinpoint the pain’s origin.
“So often, when someone comes to see us, pain is having an effect across a person’s whole body,” Burton says. “It’s often impossible to undo this chronic syndrome with one medicine or method.”
Pain relief is personal
The center addresses chronic cancer pain as follows:
Treat the pain – Pain can be treated with medications or other methods, including nerve stimulation and nerve blocks or acupuncture and massage.
Restore or prevent decreased function – Loss of function often can be improved or prevented with physical or occupational therapy.
Help patients cope with psychological issues – Patients may be dealing with residual pain and related anxiety and depression. Treatment could involve supportive psychotherapy, cognitive behavioral therapy, biofeedback or group therapy experiences. It might also include meditation or relaxation techniques.
Not everyone needs treatment in every realm, Burton says. A tailored treatment approach is most effective. For example, if pain has been going on for an extended period of time, the psychological issues may be essential to address.
On the other hand, severe, short-term pain may be handled primarily with a medication-based approach.
Medication helps many
For decades, Burton says, the medical community was optimistic that opioids, including morphine, would be a panacea for chronic cancer pain.
“The promise of 20 years ago just didn’t materialize, and now we realize it’s much more complicated than we thought it was,” he says. “These drugs still have a place in treatment, and they can often relieve pain, but their use frequently has issues.”
Potential opioid-related problems include:
- Development of tolerance (requiring higher doses)
- Lack of effectiveness (despite high doses)
Often, a “cocktail” of two or three medications is the best answer, Burton says.
These medications may include:
Anticonvulsants – Drugs made for treating seizures.
Anti-inflammatories – Drugs designed to reduce inflammation.
Antidepressants – Drugs used to treat depression.
Topical medications – Pain medicine used on the skin.
Other techniques may involve:
Nerve blocks and ablation – Two methods of addressing pain include targeted nerve blocks (injections of a nerve-numbing medication) or ablation (surgical destruction) of the nerve group that is sending pain signals.
Nerve stimulation – Small battery-operated nerve stimulators are implanted just under the skin to send electrical signals that interfere with pain-causing nerve impulses.
Patient-controlled medication – Patients can send medication directly to the nervous system by pressing a pump connected to a tube placed under the skin or close to the spine.
Vertebroplasty – This technique involves an injection of a cement-like substance into the spine to help a painful spinal fracture or disc injury.
Surgery – Traditional surgery or minimally invasive procedures may be needed to correct underlying conditions that cause pain, such as spinal injuries.
Ask for help for your pain
Burton encourages cancer patients who are experiencing pain to consult their medical care providers. It’s particularly important to get relief for acute pain that has the potential to become chronic.
Patients should ask their physician or other medical care provider to refer them to a pain management specialist if he or she is unable to help.
Burton says pain management specialists are available in most communities. These specially trained, certified experts come from varying backgrounds, including anesthesiology, neurology, rehabilitation/physical medicine, palliative care and psychiatry. While it may be the best-case scenario for a pain management specialist to be affiliated with a cancer center, it is not mandatory.