Pain is a common symptom experienced by patients with cancer and can be managed very effectively with medications, as approximately 90% of patients find relief with an appropriate plan. Cancer pain can be caused by the cancer itself, or arise as a side effect of a treatment used in cancer therapy.
Pain management techniques should be implemented as early as possible to prevent the development of persistent pain, which can lead to a significant reduction in quality of life.
Diagnosis and Assessment of Pain
Initially, it is important that there is an adequate understanding of the cause and nature of the pain in order to make the best treatment decisions.
Causes of cancer pain may include:
- Tumor obstruction of bones, nerves or organs
- Surgical procedures
It is helpful for patients with cancer pain to keep a diary of their pain symptoms, including any triggers and techniques that provided relief from the pain. This can help to improve communication between the patient and healthcare practitioner to provide a complete picture of the pain, which is useful when making treatment decisions.
Regular Pain Relief Medications
Most medications taken on a regular basis to provide pain relief are given by oral administration as this increases ease of use and is usually the most cost-effective solution. Other forms of pain relief medication may be required in some cases, including rectal suppositories, transdermal patches or injections.
For mild to moderate cancer pain, simple analgesic medications such as paracetamol or non-steroidal anti-inflammatory medications (e.g. ibuprofen or aspirin) can usually provide effective pain relief. For more severe cancer pain, prescription opioid medications such as morphine, fentanyl or oxycodone may be required to manage symptoms of pain.
Some antidepressant or antiepileptic medications such as amitriptyline or gabapentin can be beneficial in the treatment of cancer pain, particularly pain that is involved with damage to the nerves. Steroid medications such as prednisolone or dexamethasone may also be used in the management of cancer pain for some patients.
There are some non-pharmacological techniques that may help in the management of cancer pain and are often used in combination with medical treatment. These include:
- Acupuncture can help to relieve pain through the manipulation of pressure points in the body.
- Biofeedback is a technique that promotes awareness of bodily processes such as heart rate and blood pressure to influence the severity of the pain.
- Distraction techniques such as music therapy can be useful to shift attention away from the pain to a more pleasant stimulus
- Hot or cold packs can be helpful to regulate pain and provide relief.
- Hypnosis can be used to manage pain by focusing the patient’s consciousness to process pain information more effectively.
- Imagery can help promote positive feelings and allow the patient to relax when in pain
- Massage techniques can help to stimulate the muscles or nerves involved in the pain and relieve symptoms.
- Relaxation exercises can be used to refocus the attention of the patient on a specific task, such as breathing, to lessen the pain.
- Transcutaneous electrical nerve stimulation (TENS) involves the application of a mild electric current to the site to relieve pain.
Additionally, if a cancerous tumor is responsible for causing the pain, techniques to reduce the size or obstruction of the tumor offer the greatest benefit. This may involve surgical removal of the tumor or shrinking of the tumor with radiation therapy. Neurosurgery to cut or block the nerves involved in the pain pathways can also help to reduce severe neuropathic pain.
Management of Secondary Symptoms
It is common for patients with cancer pain to experience a reduction in quality of life, which may also have an impact on the emotional and psychological health. In particular, patients with chronic pain are more likely to feel anxious, depressed and be less willing to participate in social activities.
For this reason, it is essential that patients have access to a strong support network that can help them to overcome these feelings. Some patients may also require pharmacological aid to manage symptoms of depression.