Dr. Amod Manocha, Head of Pain Management Services, Max Hospital
The diagnosis of cancer has the potential of transforming and deeply invading the lives of those affected. Pain though highly individual and variable, is a common reason behind the storm of fear and anxiety associated with the diagnosis. It impacts approximately 28 percent of newly diagnosed patients, 50 to 70 percent of individuals under treatment and 64 to 80 percent of those with advanced cancer. Pain is often the reason compelling an individual to seek medical attention and leading to the discovery of the disease. When pain in cancer is so common and this is what brings an individual to seek medical care, there is no reason why pain relief should not be a treatment priority.
The incidence of chronic pain in cancer patients is rising with improving survival rates due to advances in cancer treatments. According to one study approximately 33% of cancer patients experience long-term pain and there is research evidence linking poor pain control to adverse quality of life, after all the aim is not just to survive into bare existence. The impact of uncontrolled pain extends far beyond suffering and disability, leading to physical, psychological and social issues. Problems such as loss of control, reduced strength and mobility, anxiety, fear and depression are common accomplices of uncontrolled pain. Increased demands placed on caregivers can adverse impact relationships.
Managing the cancer Pain
Pain management in cancer is indeed challenging because pain may originate from numerous factors including the cancer itself, pressure on neighbouring organs and nerves, spread to distant body parts, associated issues such as constipation and swelling of abdomen or other body parts. It could equally be the side effect of treatments such as surgery, chemotherapy or radiotherapy, or be a totally unrelated coincidental problem such as arthritis of spine. To add to the challenge some cancers grow aggressively with varying contributions from different sources of pain and this requires a regular review and therapy modification.
The good news is that a significant proportion of cancer patients can achieve satisfactory pain relief with a treatment plan that incorporates primary therapy aimed at the tumour along with pain reliving modalities including medications, interventions such as nerve blocks, physiotherapy and psychological techniques. Research evidence supports better outcomes with early treatment, so it’s advisable to seek help early. Specialist pain management input, aimed at providing maximum relief with minimum side effects, becomes more and more relevant as the complexity of the disease or the severity of pain increases.
One therapy does not work for all!
Pain control in cancer is not just about medications or injections. Satisfactory control requires attention to detail with accurate comprehensive assessment to identify pain generators and patient education to foster realistic expectations. Concomitant factors such as unhelpful believes, mood, anxiety, sense of insecurity generated by the disease and treatments, spiritual and social needs, all need to be addresses as these can amplify the perceived pain. Relaxation therapies such as meditation, mindfulness may help in managing thoughts, coping with feelings and produce a calming effect.One recipe does not work for all and an individually tailored multimodal plan of treatment incorporating pharmacological, interventional, rehabilitation, and behavioural approaches, has better chances of success.
To give you an example I recently treated an elderly gentleman with chest pain due to a big tumour pressing on the nerves coming out of the spine. Immediate pain relief was essential and he underwent cryoablation procedure which involves freezing of the affected nerves to minus 80 degrees, significantly reducing his pain within a matter of hours. This was a perfect example of latest technology being tailored to the needs of an individual requiring immediate relief in his last few days. It was comforting for all involved in his care and his family to see that he was able to spend quality time with his loved ones in his last days. Technological advancements such as availability of portable high-definition ultrasound, radiofrequency, cryoablation machines, intrathecal pump implants, spinal cord stimulators etc. have drastically refined diagnostic and interventional skills in pain management and are empowering us to keep pace with patient expectations. The genetic and molecular tests are being closely studied to enhance our understanding and will hopefully provide new targets for pain relief in the near future.
