Angela Pace believes she’s earned the right to call herself a survivor. The 27-year-old lived through a rare cancer that only one other person is known to have survived. She’s also lived most of her life with constant and severe pain.
Working closely with Bruel and others in the Pain Management Center is psychologist Diane Novy, Ph.D., who sees up to 10 patients a day. They talk about how their pain is affecting their lives and families, not just their treatment. She also sees survivors still impacted by pain and patients facing end-of-life decisions.
Novy, a professor in Pain Medicine, says cancer pain is unlike any other pain because it’s often linked with uncertainty, fear of recurrence or progression of disease, loss of control and death. Pain can be associated with or magnified by depression and anxiety, so she works closely with patients and families to understand the influence it may have on a patient’s daily life and their relationships.
“Pain is as individual as each person and each patient’s cancer experience,” Novy says, who’s been a part of the pain management team since 2001. “It’s vital that our team understands not just the physical aspects of a patient’s pain but the psychological elements as well. We talk so much about treating the whole patient at MD Anderson, and this is a great example of that philosophy.”
Among the many issues Novy, Bruel and their colleagues clue into are the fears patients and survivors may have about the long-term use of a class of prescription painkillers known as opioids. Last fall, the Food and Drug Administration (FDA) proposed new restrictions on the most commonly prescribed opioids.
“Looking back on my twentysome years at MD Anderson, I spent as much time going to appointments that addressed my pain as my cancer. It’s important to not give up, to try different things until something works for you. I’m living proof.”
“It’s vital that patients in pain from cancer or its treatment see a pain specialist,” says Salahadin Abdi, M.D., Ph.D., chair of Pain Medicine. “We agree with the FDA that there should be greater regulation of these potent painkillers. That said, it’s also important that patients who are under the care of proper specialists, and who need these medications, have access to them.”
For now, pain specialists match the right patient with the right pain management option at the right time by communicating openly, sharing information and using clinical expertise. However, that could change. In the years to come, with the introduction of personalized medicine, pain management could be more tailored to each patient’s disease and genetic makeup, in the same way much of cancer care is today.
Research in this area is just beginning, but there’s hope there may be an established biological marker to target for chronic pain, just as there are treatment targets for so many types of cancer now.
It’s one of many areas that Abdi is eager to explore with colleagues as part of an expanded research agenda for his group.
According to Abdi, previous research shows there are a number of genes affected by injury, inflammation and/or nerve damage. If those markers can be pinpointed, there may be better opportunities to predict which drugs or therapies are most effective for each person’s pain.
“We’re moving into this exciting new era of genetics and pharmacogenomics in pain management, and we’re just starting to understand the many possibilities,” he says. “MD Anderson is the ideal place to explore and apply the science behind pain because we have the expertise, resources, spirit of collaboration and patient focus.”
Abdi and his colleagues also are pursuing research on the use of nanotechnology to deliver some anesthetics directly to a pain site. And there are early studies underway looking at how free radical scavengers may be used to alleviate pain in patients who have neuropathy.