More than half of patients with advanced cancer experience pain. Cancer pain affects quality of life and therefore pain management is essential. There is also evidence that improving symptom control can help advanced cancer patients live longer.
AARO doctors are oncology-trained and able to provide first-line management of cancer pain. They will:
1. Assess your pain
2. Manage it accordingly with medications, and radiotherapy if indicated
3. Co-ordinate with other specialists as appropriate for specialized pain management procedures or treatment of the underlying cause
Some Frequently Asked Questions (FAQs) about cancer pain management
How will my pain be assessed?
You will first undergo a comprehensive pain assessment where your doctor will talk to you and understand the pain you are experiencing. If necessary, further investigations will be done to identify the cause of the pain. He will also look at your current pain management plan, and how well you are responding to it. Your family and caregivers will also be engaged to optimize your support system. Goals and expectations of pain management will be discussed before a plan is formulated.
What can be done to get on top of cancer pain initially?
Pain medications are the typical first measures to control cancer pain. Your doctor will prescribe the type of pain medication suitable for the severity of the pain, and schedule review appointments to adjust the medications until you are comfortable. During this time, you might be asked to keep a pain medication diary, which will help to determine how well the medications are working.
While opioid medications like morphine are among the most effective medications for moderate to severe cancer pain, patients are hesitant to start them for fear of side effects like constipation and drowsiness, or of addiction and dependence. Your doctor is trained to anticipate, prevent and manage these side effects. Some associate morphine use with the end stages of cancer and dying, however, use under professional supervision can benefit patients at many points of the cancer journey. By balancing the pain relief and alertness levels, patients can maintain independence and a reasonable quality of life.
Besides standard pain medications, there are also complementary medications that help with particular types of pain, like nerve pain which is often shooting or burning in character. Anticonvulsants and antidepressants have been shown to be useful in such situations, and may allow reduction in opioid medication usage.
How can radiotherapy help with cancer pain?
Bone metastases (spread of cancer to the bone) is a common cause of cancer pain, and are particularly common in patients with advanced breast, lung and prostate cancers. Radiotherapy to affected bones has been shown to be effective, with 60-80% of patients reporting pain improvement after radiotherapy. With improvement in pain from radiotherapy comes other benefits like improved mood, less insomnia, less constipation and better quality of life.
Radiotherapy for bone pain can be given in a single or multiple (usually 5 or 10) sessions, depending on the patient’s overall condition. Studies also show that if radiotherapy is given when pain is moderate, there is a higher chance of the pain completely going away than if the pain was severe at the start of treatment. Therefore, early assessment of bone pain by a radiation oncologist will be helpful in determining the right time to use radiotherapy.
Tumour masses can press on or invade nerves and cause nerve pain. They can also stretch or irritate the normal tissues around it. Radiotherapy can be used to target these tumour masses and shrink them, thus relieving the pressure on the nerves or normal tissues, and reducing pain.
Are there specific drugs that can help with bone pain caused by cancer?
The weakening of bones affected by cancer can result in bone pain. There are drugs that can prevent or slow down this weakening. These include Denosumab which is injected just under the skin every four weeks, or Zometa which is injected through a vein every 4 or 12 weeks. These drugs also reduce complications of bone metastases like fracture, compression of the spinal cord and high blood calcium levels.
What are the other measures available for persistent or hard to treat cancer pain?
If opioid medications or non-invasive measures like radiation therapy do not improve pain sufficiently, various interventional techniques can help, depending on the specific pain condition. Interventional techniques usually involve injections but are less invasive than open surgery. These should be performed by specialists in the technique.
A backbone that has been weakened by cancer can fracture and become flatter. This leads to instability that gives rise to severe back pain. In some cases, there are techniques to restore the height of the backbone and improve stability, without going through open surgery. One way is to inject bone cement into the backbone (vertebroplasty). Sometimes, a special balloon is introduced into the backbone via a needle and inflated to restore its height, before filling the space created with bone cement (kyphoplasty). Both are done under x-ray guidance by a specialist in the technique.
Tumours can press on or surround nerves and cause neuropathic pain. These nerves give off pain signals that can difficult to manage with just conservative measure. Nerve blocks can be done to give relief. This involves injection of local anaesthesia to the affected nerve or nerve network. For particularly persistent pain the affected nerve networks are injected with substances that destroy them. One classic example of this is in pancreatic cancer whereby the tumour invades the nearby celiac nerve plexus. A celiac axis block is usually a safe and effective way to alleviate the pain.
In Summary
Patients with advanced cancers often experience cancer pain that can be overwhelming. Fortunately, there are a wide range of methods to overcome this pain and its disabling effects on their daily lives. It can range from something as simple as understanding the pain process and prescribing the right painkillers to undergoing an appropriate interventional procedure.
Oncologists are trained to be first-line responders for patients with cancer pain, and to assess which cancer treatment method can give patients the most benefit for their symptoms, be it chemotherapy, radiotherapy or an interventional procedure. They can also co-ordinate referrals to the relevant specialists for hard to treat, persistent pain. Having your oncologist coordinate all efforts for cancer treatment and pain control at the same time will benefit patients by ensuring the optimal sequencing of all therapies as well as reducing unnecessary consultations and treatments. For a comprehensive pain assessment at AARO, kindly send us an enquiry or contact us at the provided hotline number.
