Cancer Pain Syndromes
Pain is defined as the impact of a physiological series of electrical and chemical events occurring in the body.
According to the International Association for Study of Pain, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
Cancer Pain Syndromes
Cancer patients experience pain in multiple sites in the body, resulting from a series of causes and reflecting various symptoms. Cancer pain can range from being short-lived or long-lasting, mild or severe. It can affect one or a few organs, bones or organ systems.
Research shows that approximately 30% to 50% of people with cancer will experience cancer pain in the course of treatment. On the other hand, a whopping 70% to 90% of people with advance cancer experience bouts of cancer pain.
Certain typical pain mechanisms present themselves in cancer patients. These include inflammation due to infection, obstruction of a hollow organ, destruction of tissue or growth of a tumour in a closed area richly supplied with pain receptors.
A majority of individuals who suffer from the cancer pain syndrome suffer more because of lack of awareness and control over their problem.
It is important for the patients suffering from cancer pain syndromes to know that they have a full right to good pain control. It is necessary for them to know that:
- Most pain can be controlled
- Communication is important
- Pain can be measured
- Patients and health care providers can work in tandem for effective pain control
Types of Cancer Pain
An individual suffering from the cancer pain syndromes generally experiences two types of pain, nociceptive pain and neuropathic pain. Here we give a brief description of each for the reader’s benefit.
i) Nociceptive Pain
This type of pain is caused by damage to the tissue and is usually described as a sharp, aching or throbbing pain. The nociceptive pain occurs due to the tumours or cancer cells that grow larger and crowd body parts near the cancer site. Such pain might also result from cancer that has further spread to the bones, muscles or joints.
ii) Neuropathic Pain
This type of pain occurs when there is actual nerve damage. It might result from a tumour pressing on a nerve or a group of nerves. Those experiencing this type of cancer pain often describe it as a burning or heavy sensation or even numbness.
Causes of Pain
For a patient suffering from the cancer pain syndrome, there can be many causes of the pain. The most important amongst these are:
a) Pain from the tumour
In most of the cases, cancer pain arises when a tumour presses on bone, nerves or body organs. The pain might also vary according to the location. For instance, a small tumour located near a nerve or the spinal cord may be very painful. On the other hand, a larger tumour elsewhere might not cause that much discomfort.
b) Pain related to cancer therapy
Treatments such as chemotherapy, radiotherapy and surgery are another cause of pain. Suppressed immune systems resulting from these therapies are also known to cause pain in many patients.
Other causes might have no correlation with your specific illness. These can include headaches, muscle strains, arthritis, kidney stones, herniated disk in the back and the like.
The cancer pain syndrome can be managed effectively using a judicious combination of pharmacologic and non-pharmacologic treatments.
A) Pharmacologic treatment
Here we list the main medications involved in the treatment of pain along with a few examples.
Nonopioids – Acetaminophen, Aspirin, Ibuprofen Opioids – Morphine, Hydromorphone, Hydrocodone, Oxycodone, Fentanyl Antidepressants – Amitriptyline, Imipramine, Doxepin, Trazodone Antiepileptics – Gabapentin Steroids – Prednisone, Dexamethasone
Other therapies include:
Radiation therapy Nerve blocks/Implanted Pump Neurosurgery Surgery
B) Non-pharmacologic treatment
The main non-drug treatments include:
Biofeedback Breathing and relaxation exercises Distraction Heating pads and hot/cold packs Hypnosis Imagery Massage, pressure and vibration Transcutaneous Electrical Nerve Stimulation (TENS) Rest
Most of the medicines for this purpose are taken orally, in liquid or tablet form. However, at times, patients who cannot consume the medication in this manner are also offered other options, including:
Rectal suppositories Transdermal patches Injections (Subcutaneous, Intravenous, Epidural, Subdermal and Intramuscular)