Cancer pain – how can it be relieved?

Pain is one of the symptoms accompanying cancer. Its sources can be different – the cause can be both the cancer itself and the treatment. According to researchers about 30-40% of patients suffer from it at the stage of cancer diagnosis. In people already undergoing treatment, this ratio increases to 50%, and in advanced cases it may be present in 90% of cases. However, there are effective ways to deal with pain. So how to deal with it?

What is cancer pain?

The pain is caused by a growing tumor that puts pressure on the surrounding tissues. Other reasons for its occurrence are tissue destruction, invasion of other organs, and organ dysfunction. Pain also occurs during the treatment itself – as a result of surgery, radiotherapy or infection. Determining the cause and nature of pain plays a key role in treating it. A major problem during the pain treatment is end of dose pain that occurs in patients who are treated with opioids. It occurs when the effect of the drug wears off, which is when the levels of the drug in blood drop. Many patients also suffer from breakthrough pain that occurs suddenly, worsens very quickly and is paroxysmal. It occurs in patients being treated with opioid painkillers and supportive medicines. They can be triggered by stress, exercise, and coughing.

Pharmacological methods of pain relief

As part of pharmacological pain management, painkillers are used. They can be administered either orally or intravenously. Currently, cancer pain is treated on the basis of the so-called the analgesic ladder. This pain management system distinguishes three levels of treatment intensity depending on the pain intensity level experienced by the patient:

• First step – mild pain intensity and treatment with non-opioid drugs;
• Second step – moderate pain and treatment with weak opioids;
• Third step – very severe pain and treatment with potent opioids.

A key element in the treatment of pain is the regularity of doses and adherence to fixed hours

Non-opioid analgesics

This group of drugs includes paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) – Ibuprofen, Diclofenac, Naproxen, Ketoprofen, Acetylsalicylic acid, Nimesulide, Metamizol. When using them, particular attention should be paid to toxicity to organs such as the stomach and kidneys. People who suffer from blood clotting disorders and cardiovascular failure should take particular caution.

Opioid analgesics

Drugs of this group are divided into two types:

• Weak opioids – their dosage is limited; this type includes Codeine, Dihydrocodeine (DHC), and Tramadol;
• Strong opioids – no maximum doses are defined in these cases; this type includes Morphine, Methadone, Oxycodone and Fentanyl.

Complementary pharmacotherapy

Antidepressants

Due to the influence of pain on the mental health of patients, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, which can be used together with opioids, are often used in the treatment of chronic cancer pain. They also show a positive effect in the treatment of neuropathic pain.

Antiepileptic drugs

According to specialists from Imperial College London Department of Surgery and Cancer in London, also antiepileptics are effective in the treatment of neuropathic pain. They work by inhibiting the excessive activity of neurons, which is characteristic not only of epilepsy, but also of neuropathic pain.

Corticosteroids

A popular method of relieving the pain are corticosteroids (e.g. cortisol), i.e. hormones produced by the cortex of the adrenal glands that have anti-inflammatory and analgesic effects. The indication for their use is high intracranial pressure and disseminated pain in the skeletal system.

Non-pharmacological methods of pain management

In some cases, it may be necessary to resort to non-pharmacological pain treatments. One of such methods is a blockade, which consists in local anesthesia of the nerves located directly at the organ affected by the neoplastic disease. It can be:

• Peripheral – performed mainly for diagnostic purposes, but the effect lasts only for a certain period of time;
• Vertebral column – used for both diagnostic and therapeutic purposes, and its effect lasts from several weeks to several months;
• Epidural – it is used in patients who experience severe pain in the lower limbs.

Another effective treatment for pain is neurolysis, that is the destruction of nerve fibers with a specialized substance. In this case, the effect lasts up to several months and the method itself is most often used in palliative patients.

Alternative methods of cancer pain treatment

In addition to the above-mentioned methods, there are a number of other ways to help fight cancer pain. One of them that is becoming more and more popular is medical marijuana treatment. The cannabinoids (CBD) found in this plant stimulate the nerve connections to alleviate the symptoms associated with the disease, including pain. At the same time, it does not cause side effects, it is natural and not addictive.

Psychological support for a person suffering from cancer

Cancer is a disease that is exhausting not only physically but also mentally. People who experience additional pain during treatment may feel discouraged and become apathetic. A visit to a psychologist can be a great support – it allows you to better understand emotions and gain a new perspective on the disease. The relatives of the person with cancer, who constitute a kind of support group, also play a very important role in oncological treatment.

If you're looking for more information on what else you can do to help someone with cancer, see our article: How To Talk With Someone Who Has Cancer?