Cancer Pain: Understanding and Managing It for Better Quality of Life

By Dr. Vivek Loomba, Indian Spinal Injuries Centre, Vasant Kunj

Table of Contents

• General Information About Cancer Pain
  • Cancer Pain and Its Causes
  • The Role of Pain Management
  • Personalizing Pain Management
• Assessment of Cancer Pain
  • Evaluating the Pain
  • Physical and Neurological Exams
• Using Drugs to Control Cancer Pain
  • Mild Pain
  • Moderate to Severe Pain
• Other Treatments for Cancer Pain
  • Non-Drug Therapies
  • Psychological Support
• Treating Cancer Pain in Older Patients
  • Close Monitoring Is Key
  • Non-Pharmacological Approaches
• Peripheral Neuropathy: A Common Side Effect
  • What Is Peripheral Neuropathy?
  • Managing Peripheral Neuropathy
• The Long-Term Impact of Cancer Pain
  • Pain After Treatment
  • Improving Quality of Life
• To Learn More About Cancer Pain

General Information About Cancer Pain

Cancer is a physically and emotionally challenging disease, and one of the most difficult aspects is the pain that often accompanies it. Managing cancer pain is crucial for improving a patient’s quality of life. Whether the pain comes from the cancer itself, treatments, or diagnostic tests, a personalized plan for pain relief is essential.

Cancer Pain and Its Causes

Cancer pain can stem from the disease itself, cancer treatments, or even the diagnostic tests used to detect and monitor it. The nature of this pain varies. Tumors can press on bones, nerves, or organs, causing acute discomfort. Similarly, treatments like surgery, radiation therapy, and chemotherapy can induce their own forms of pain, such as inflammation, peripheral neuropathy, or long-term side effects.

The Role of Pain Management

Pain control can significantly improve the quality of life, allowing patients to maintain normal activities, sleep better, and feel more in control. This doesn’t mean eliminating pain completely for everyone, but it’s about reducing pain to manageable levels through a combination of treatments tailored to individual needs.

Personalizing Pain Management

Each patient’s experience with cancer and its related pain is unique. The key to managing cancer pain lies in developing a personalized approach that takes into account the patient’s medical history, the type of cancer, and the treatment regimen. A multi-modal approach can include medications, physical therapy, relaxation techniques, and even psychological support.

Assessment of Cancer Pain

Evaluating the Pain

Assessing cancer pain is the first step toward effective treatment. Your healthcare team will ask a series of questions to understand the nature and severity of the pain. Expect questions about when the pain started, its location, and its intensity on a scale of 1 to 10. They may also ask what makes the pain better or worse and whether it’s continuous or intermittent.

Physical and Neurological Exams

In addition to verbal assessments, physical and neurological exams are crucial in planning pain management strategies. These exams help identify the exact causes of pain, such as pressure on nerves, inflammation, or tissue damage. The exams also guide doctors in prescribing the right combination of therapies and medications, as well as monitoring the patient’s progress.

Using Drugs to Control Cancer Pain

Pain can be categorized as mild, moderate, or severe, and different drugs are prescribed based on the pain’s intensity. Some commonly used medications include:

Mild Pain

For mild pain, acetaminophen (paracetamol) and nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first line of defense. These drugs help reduce inflammation and relieve pain without the need for stronger opioids. Common NSAIDs include Celecoxib, Diclofenac, Ibuprofen, Ketoprofen, and Ketorolac. However, these medications can cause side effects, especially in older patients, and require close monitoring.

Moderate to Severe Pain

When pain becomes more intense, opioids are often added to the treatment plan. Opioids work by interacting with the brain’s pain receptors, significantly reducing the sensation of pain. These drugs can be very effective but also carry a risk of side effects like drowsiness, nausea, or constipation. Strict medical supervision is needed to avoid dependence and manage side effects.

Other Treatments for Cancer Pain

Non-Drug Therapies

In addition to medications, several non-drug treatments can help manage cancer pain, including:

• Physical Therapy: Exercises that strengthen muscles and reduce strain on painful areas.
• Acupuncture: A traditional practice that stimulates the body’s natural pain-relieving chemicals.
• Nerve Blocks: Injecting local anaesthetics to block pain signals from specific nerves.

Psychological Support

Chronic pain can affect mental health. Psychological therapies, such as cognitive-behavioural therapy (CBT), support groups, and counselling, can help patients manage pain by improving how they perceive it and teaching coping mechanisms.

Treating Cancer Pain in Older Patients

Close Monitoring Is Key

Older adults present unique challenges in pain management, as they are more susceptible to drug side effects. For older patients, NSAIDs should be used cautiously due to potential risks to the kidneys, heart, and digestive system. Opioids must also be carefully monitored to prevent complications like confusion or respiratory issues.

Non-Pharmacological Approaches

For many older patients, non-drug therapies, such as gentle physical therapy, massage, and relaxation techniques, are essential in managing pain without the need for strong medications. Psychological support is equally critical, as older adults are more likely to experience isolation or depression that worsens their perception of pain.

Peripheral Neuropathy: A Common Side Effect

What Is Peripheral Neuropathy?

Peripheral neuropathy is a condition where nerve damage causes pain, numbness, and tingling, often in the hands and feet. It can result from chemotherapy, radiation, or the cancer itself. This condition can significantly impact quality of life and make simple tasks, such as walking or using one’s hands, difficult.

Managing Peripheral Neuropathy

Neuropathy can be managed through a combination of medications, lifestyle changes, and physical therapy. For instance, nerve pain drugs like Gabapentin or Pregabalin are commonly used. Physical therapy may also improve balance and strength, reducing the risk of falls. In some cases, reducing the dose of chemotherapy drugs can also alleviate symptoms.

The Long-Term Impact of Cancer Pain

Pain After Treatment

Some cancer survivors continue to experience pain long after treatment ends. This is known as chronic cancer pain or post-treatment pain. Even though the cancer may be in remission, nerve damage, scar tissue, or the effects of surgery and radiation can cause ongoing discomfort.

Improving Quality of Life

Living with chronic pain is challenging, but many strategies can help manage it. For instance, relaxation techniques, including yoga and meditation, have been shown to reduce the intensity of pain. Moreover, working with a pain specialist can help survivors find the right combination of medications and therapies to enhance their overall well-being.

To Learn More About Cancer Pain

To learn more about cancer pain, including new research and treatment options, reach out to your healthcare provider or pain specialist. The Indian Spinal Injuries Centre in Vasant Kunj has a dedicated team to support patients through pain management, providing personalized care and the latest pain relief options.

Contact:

Dr. Vivek Loomba, Pain Management Doctor, Indian Spinal Injuries Centre, Vasant Kunj.