Cancer Pain

Many patients with cancer suffer with severe pain. The pain associated with cancer has a negative impact on the individual’s functional status and quality of life. Effective pain management will improve a patient’s well-being and overall quality of existence.

How common is cancer pain?

Pain affects 20% to 50% of people diagnosed with cancer. Approximately 80% of patients with advanced cancer report moderate to severe pain. In one large meta-analysis, more than 50% cancer patients reported pain. In addition, cancer pain often affects multiple body sites, and younger patients have more cancer pain than older people.

How does cancer pain impact the patient’s life?

Cancer pain causes increased emotional distress. Both pain severity and duration correlate with a risk for depression. According to the American Cancer Society, cancer patients are disabled 12-20 days each month, and 30-50% are unable to work due to their disease.

Cancer survivors often suffer from complications related to their treatments, as well as loss of support from healthcare providers who discharge them back to their primary care team. According to a recent study, 50% of cancer patients reported pain and functional limitations years after treatment. Untreated pain often leads to unnecessary hospital admissions, frequent trips to the emergency department, and suicide.

What are the steps of cancer pain management?

Effective pain management can be accomplished by following certain steps. These steps are:

  • Regular screenings – To ensure the pain is recognized early.
  • Identifying underlying pathology – This involves assessment of the cancer pain to determine cause.
  • Determining if the pain needs treatment – Some pain is multifactorial in nature, so the doctor must decide how to treat it.
  • Choosing the right pharmacologic and interventional treatment options – Not all medicine works for every patient, just as not every patient responds to interventional pain management.
  • Providing proper education concerning pain treatment – This includes administration, expected side effects, and associated therapies.

What are the causes of cancer pain?

In a large review of studies, 59% of patients report pain after cancer treatment. Causes of cancer pain include:

  • Infusion-related pain syndromes – Intravenous chemotherapy causes venous spasm, vesicant extravasation, chemical phlebitis, and cycle-associated flare. These conditions can lead to intense pain and severe discomfort.
  • Treatment-related mucositis – This is the medical term for a sore mouth. Patients with mucositis have both nociceptive and neuropathic pain.
  • Chemotherapy-related musculoskeletal pain – This pain originates in the hips, back, thighs, shoulders, legs, and feet. It is worsened with walking, weight-bearing, and tactile contact.
  • Dermatologic complications – Many cancer patients report shingles outbreaks, which are extremely painful. Palmar-plantar erythrodysesthesia is a syndrome that flares up after receiving chemotherapy. This causes pain of the hand palms and soles of feet.
  • Radiation-induced pain – Radiation therapy can lead to pain flares, severe dermatitis, and mucosal inflammation.

How is cancer pain treated?

Depending on the site of pain, treatment involves:

  • Celiac plexus block – This pain by blocking pain signals traveling from the abdomen to the brain. The doctor injects anesthetics onto the affected nerves. Based on current studies, the success rate for pain relief with this block is around 80%.
  • Sympathetic nerve block – This is used to treat complex regional pain syndrome (CRPS), as well as shingles. These medications are administered onto the nerves.
  • Intrathecal pump implant – This is used for chronic cancer pain. A small device is inserted near the spinal cord to deliver the medications. Based on a recent study, intrathecal pain pumps have an 86% success rate.
  • Medications – The doctor can prescribe narcotic analgesics in pill form, topical agents, or intravenous medicines.

Resources

Corrado P, Alperson B, & Wright M (2008). Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients. Neuromodulation, 11(2), 98-102.

Puli SR, Reddy JBK, Bechtold ML et al. (2009). EUS-Guided Celiac Plexus Neurolysis for Pain due to Chronic Pancreatitis or Pancreatic Cancer Pain: A Meta-Analysis and Systematic Review. Digestive Diseases, 54(11), 2330-2337.

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