About Cancer Pain
The No 1 killer disease in Singapore is cancer. While treatment for cancer (chemotherapy, radiation and hormonal therapy) has been improving rapidly through the years, many patients still die from cancer every year – and many of them suffer greatly from cancer pain. For many, the most frightening part of having cancer is the threat of pain. At Singapore Paincare Center, we help our cancer patients with difficult and refractory pain, improving their quality of life and restoring dignity to them in their time of need. While the oncologist focuses on treating and curing the cancer, patients can be confident that pain is treatable and manageable.
At Singapore Paincare Center, we are at the leading edge of cancer pain-relief technology, having access to advanced equipment and up-to-the-minute techniques and medical procedures that allows our team of specialists to find the exact source of the pain and determine the best way to ease patients’ suffering.
Types of Cancer Pain
Pain can be related to the cancer itself or to the treatments needed to combat it. Causes of pain may include:
- A tumour may be pressing against an organ, expanding and stretching surrounding tissues
- Tiny cancer cells may get inside the bones and cause pain
- Sometimes, a cancer nerve can spread pain wherever it travels in the body, making the patient hurt in places away from the cancer area (known as referred pain)
- Cancer treatment-related pain:
- Chemotherapy can cause numbness, tingling or pain – usually in the feet, legs or hands
- Radiation DXT can cause affected areas to become inflamed
- Surgery to remove a tumour may itself be a cause of pain
Often, doctors find pain hard to assess because it is highly subjective. That is, one patient may describe his or her pain as severe, while another experiencing the same degree of pain may describe it as mild. Patients also tend to downplay the pain they experience when they visit their doctor because they are focused on what is happening at the moment, do not want to seem like a complainer or because cultural differences come into play. It is important that patients report all aspects of pain as honestly and fully as possible so that doctors can determine the best treatment methods.
How is Cancer Pain Assessed?
Pain specialists take into consideration:
- Severity – Doctors commonly ask patients to rate pain on a 1 to 10 scale
- Time factors – How often, for how long and what time of day the pain occurs
- Location – In one place or several, in a large area or a small one
- Quality – Stabbing, burning or crushing
- Modifying factors – Movement or activities that make the pain better or worse
In most cases, pain specialists follow what is called the “pain ladder” when planning treatments for cancer patients. The first rung on the ladder is analgesic medication, such as Synflex, Voltaren, Celebrex or Arcoxia, to stronger drugs known as Tramadol or Codeine. If these do not relieve the pain still, stronger medications containing morphine are given. For patients who do not like oral medication, there are sustained release morphine-like patches (Durogesic) that give good long-lasting relief. If even further relief is needed, the doctor goes up another rung on the ladder, which is to give higher doses of the strongest medications. Unfortunately, some pain medications may cause certain patients to experience unpleasant side effects, like nausea, drowsiness and constipation. Not infrequently, other non-pain killers can be effective in the treatment of cancer pain (eg, Lyrica, Amitriptyline, Lexapro and Alprazolam).
Interventional Pain Procedures: Neurolysis
Non-medicine treatments are sometimes added to the pain-relieving process. In certain types of cancer pain that are localized, chemicals may be introduced to the nervous supply of that area through minimally invasive techniques. These medications block the pain and “burn-off” further painful nerves. The effect can last from 6 months to 2 years. The neurolysis procedures potentially can treat liver, stomach, pancreatic and colonic cancer pain. Spinal and nerve pain within the chest arising from cancer invading the nerve can be treated successfully with this ablative procedure.
Advanced Pain Control: Intrathecal Drug Delivery
Some pain conditions can be very painful and refractory, eg, cancer pain with bony metastasis, neuropathic pain secondary to cord myelopathy and many others. In these cases, despite optimization with Morphine, the pain relief does not increase accordingly but yet the side effects escalate. Patients develop distress and disappointment, progressing to depression and reduced quality of life.
Most pain medication act on the spinal cord as this is where all the pain receptors are. All oral medications, after oral administration, undergo metabolism and breakdown before they finally reach the pain receptor in the spinal cord.
In intrathecal administration, the drugs are applied directly into the spinal cord. This allows for reduced amounts of medication needed to achieve the desired pain control without the associated side effects.
All of it goes into the pump that delivers a set amount of the drug into the spinal cord. This computerized pump delivers very exact amounts of medication without fear of overdosing or underdosing. Patients will return for refill of medication in the pump once in a couple of months. This small pump will be implanted into the patient.
Advantages of IT pump:
- Better pain control with less medication
- Increased survival, compared to poorly-controlled cancer pain
- Less sedation effects, with more clear-headedness
- Less side effects of medications (eg, constipation and nausea)
- Increased patient satisfaction
- Less oral medication
- No need for frequent follow-ups
Before this treatment, patients would be very disabled by the cancer pain, and distressed with concomitant sedation side effects. After implantation of this device, they would be able to go for holidays and enjoy quality of life.