Cancer is a devastating diagnosis that rips through the lives of patients and their families. Even with promising new treatment options for all kinds of cancer, cancer pain is one complication that can be challenging to treat.
Pain is common in cancer patients, particularly in the advanced stage of disease when the prevalence is estimated to be more than 70%,contributing to poor physical and emotional well-being. The most comprehensive systematic review indicates pain prevalence ranging from 33% in patients after curative treatment, to 59% in patients on anticancer treatment and to 64% in patients with metastatic, advanced or terminal disease.
Increased survival with either life-prolonging treatment or curative treatment results in increased numbers of patients experiencing persistent pain due to treatment or disease, or a combination of both.
Approximately 5%–10% of cancer survivors have chronic severe pain that interferes significantly with functioning.
CANCER PAIN CAUSES
The amount of pain you have with cancer depends on:the type of cancer you have,where it is,the stage of your cancer and whether the cancer or treatment has damaged any nerves.but how you feel pain, such as fear, anxiety, depression and a lack of sleep have a massive influence on your pain.
Chronic cancer pain can be due to changes to the nerves called neuropathic pain. Nerve changes may be due to cancer pressing on nerves or due to chemicals produced by a tumour.
People often describe nerve pain as burning, shooting, tingling or a feeling of crawling under their skin. It can be difficult to describe exactly how it feels. Nerve pain can sometimes be more difficult to treat than other types of pain.
Some people have long term nerve pain after surgery. Nerves are cut during surgery and they take a long time to heal because they grow very slowly.
Nerve pain can also happen after other cancer treatments, such as radiotherapy or chemotherapy.
Cancer can spread into the bone and cause pain by damaging the bone tissue . You might also hear bone pain called somatic pain. People often describe this type of pain as aching, dull or throbbing.
Soft tissue pain means pain from a body organ or muscle. For example, you might have pain in your back caused by tissue damage to the kidney. You can’t always pinpoint this pain, but it is usually described as sharp, cramping, aching, or throbbing. Soft tissue pain is also called visceral pain.
Chronic cancer pain can also present as phatom limb pain. Phantom pain means pain in a part of the body that has been removed. An example is pain in the breast area after removal of the breast (mastectomy). Phantom pain is very real and people sometimes describe it as unbearable.
Lastly people can feel chronic cancer pain from an organ in the body but in a different part of their body to their cancer this is called referred pain.
Chronic cancer pain continues long after the injury or treatment is over and can range from mild to severe. It can be there all the time.
Chronic cancer Pain can greatly affect your quality of life ,it can make it hard for you to do everyday things such as bathing, shopping, cooking, sleeping and eating.This can be hard for your close friends and relatives to understand.
CANCER PAIN CONCERNS
Those who have been diagnosed with cancer or undergoing treatment for cancer are likely to experience painful side effects. Cancer pain may not be appropriately treated by other factors leading to undertreated pain.
Some health care providers and cancer clinic doctors may not be asking you specifically about your cancer pain or ask about it routinely during your clinic visit. This may be due to lack of experience dealing with this type of pain and proper cancer pain treatments. This is when a referral to a cancer pain specialist may be beneficial to both you and your clinic doctor in helping to treat your cancer pain. There also is the perception that prescribing pain medication can lead to abuse of these pain medications
Sometimes, the cancer patients themselves do not speak up about the cancer pain they are in and this can also lead to less optimal treatment of your cancer pain. This can be because of the false perception that nothing can be done and they have to deal with the cancer pain.
TREATMENT OPTIONS FOR CANCER PAIN
Because cancer pain is complex, we begin by conducting a comprehensive assessment to understand the cause(s) of the pain, the severity, how the individual is affected and what matters to the patient. Based on this information, an individualized pain treatment plan that best meets your needs and preferences
Treatments vary and may include one or more of the following approaches to target different aspects of pain:
– PAIN MEDICATION
Most pain can be effectively managed with a combination of medications. Multiple types and classes of medications can be used depending on the type and severity of a patient’s pain. In addition to traditional pain medications (for example, nonsteroidal anti-inflammatories, acetaminophen and opioids) patients may find relief from drugs used to treat other diseases, such as anti-seizure medications and anti-depressants. Despite guidelines and the availability of opioids (the mainstay of moderate to severe cancer pain management), undertreatment is common.
Medications are carefully chosen and adjusted for optimal pain management.
Medicinal cannabis provides an alternative medication option to help manage cancer pain when conventional medication have failed to provide effective pain management .
– NTERVENTIONAL PAIN PROCEDURES
Nerve pain is common in the cancer journey. In some situations nerve blocks can be performed as simple day case procedures. These act to temporarily numb the nerve. Often, the benefit of these is short lived so longer-acting nerve techniques can be used. These act to reorganise the nerve so it is less sensitive to sending pain signals and their benefit can last for many months. There are two forms – pulsed radiofrequency and radiofrequency ablation. In many instances of cancer pain a pulsed procedure is used which does not damage the nerve but instead reorganises the nerve to stop it sending severe pain signals. Radiofrequency ablation is used less often and “cauterises” the nerve.
– ADVANCED INTERVENTIONAL PAIN PROCEDURES
If pain is chronic or severe and not responsive to medications or simple treatments then there are a number of options available that should be considered. These are not common and not suitable to all the types of pain but can provide excellent pain relief. The two main advanced treatments are spinal cord stimulation and intrathecal pump. These serves are accessed via onward referral to a specialist centre. In cases of severe or chronic nerve pain these are invaluable. The second option – the intrathecal pump- is a way of providing strong pain relieving medication to the spine when normal medications aren’t working or causing too many side effects. Both involve careful planning, minimally invasive techniques and short hospital admissions but can provide excellent pain relief in the right situation
It is common for patients to be treated for multiple conditions that evolve during or after cancer treatment