Many people fearful of cancer pain more than anything else. Luckily, although pain management for cancer patients is still evolving, there are some alternatives available for them. Perhaps nothing is more dreadful than a doctor telling you that you have cancer. And it’s frightening to think that 50 percents of men and 33 percents of women will get cancer at some points in their lives.
More than a hundred types of cancer can grow inside our bodies, from our bones and skin to our blood and our internal organs. All cancers are caused by overactive runaway cells that somehow replicate wildly. Those turncoat cells may spread to the entire body and invade healthy tissue. A process known as metastasis is what makes cancers such a monster. Almost all people at advanced stage of cancer have chronic pain, and some people with early stage of cancers also have pain. However, certain cancers, such as lymphoma and leukemia, aren’t painful at all. Generally, pain appears when cancer is accompanied with malignant tumors.
Cancer pain is described as throbbing, sharp, burning, and aching. It is usually due to the pressure of tumors on healthy tissues, vessels, and organs. Bone pain is also typically found on an advanced cancer, as the disease invades the skull, spine, or other bones. Pain on cancer patients can also be caused by:
- The lack of bloodflow on vessels that are squeezed by tumors
- Inflammation due to growing tumors
- Musculoskeletal pain due to immobility
Regrettably, cancer patients are susceptible to these pains. Additionally, cancer may secrete certain substances that can further aggravate pains.
If cancer patient experiences changes in his bladder and bowel function and/or a piercing pain in his neck or back, the cancer may already reach the spine. The metastasize process may cause paralysis and other debilitating problems, so it’s important get help immediately. Tumors can be treated by surgery or radiation. It’s not an enjoyable prospect, but pain on top of other pain (breakthrough pain) may easily attack cancer patients. Breakthrough pain happens when someone has incessant pain, despite taking painkillers, pain still breaks through, causing the pain intensity to soar. Most cancer patients report this severe pain. Opiates is often used to deal with breakthrough pain, it is a long-acting drug that is combined with short-acting drug.
Opiods are the primary component of cancer pain treatment. Each type of opiod helps with different kinds of pain.
Short-acting opiods: It is recommended for treating pain that strikes when you are active, such as when you are working at office, gardening, or doing household chores, a doctor may prescribe it to help you perform activities more smoothly. Oxycodone or hydromorphone are examples of short-acting opiods.
Long-acting opiods: It is recommended if your pain occurs constantly. Duragesic, OxyContin, Methadone, and MS Contin are examples of long-acting opiods. You may also be given a minimal effective dose of short-acting opioids to enhance the overall effect.
However, most people who have been taking opiods for years may need an increasing dosage to get the same level of effect. There are ways that you need to do if you’re developing tolerance, including using another type of opiod and taking NMDA antagonist to lower pain sensitization. In later stages of cancer, oral medication may not be possible due to nausea. Opiod that comes as skin patch, such as Fentanyl, should be a better option as it doesn’t involve digestive system. Medical providers may also administer opiods through other routes, for example by using less invasive methods including infusions or injections. More invasive methods may include direct tube insertion to the spinal cord. Additionally, PCAs (patient-controlled analgesic devices) give you the freedom in choosing the most convenient delivery method.
If the opiods you are taking make you drowsy and inattentive, your doctors can prescribe other drugs to minimize these side effects, such as adjuvants (or helper pain drugs) or stimulants. If this method is successful, you can use lower opiod dose. Adjuvant analgesics can’t relieve pain alone without opiods, but instead can improve the relieving effects of analgesics. Your doctor may prescribe these drugs along with NSAIDs and opiods. Adjuvants are also useful for bone pain and can work with bisphosphonate and antidepressant.
Common Drugs for Cancer Pain
• Antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline), can relieve nerve pain and help patients sleep better. However, it may cause gastrointestinal problems and dizziness. The drugs may take two or three weeks to have a full effect.
• Anticonvulsants, such as Gabapentin (Neurontin), were originally developed to deal with seizures, these drugs can relieve burning or tingling from neuropathic pain (nerve injury). Like antidepressants, these drugs may take awhile to work. If you are taking anticonvulsant, the doctor often runs drug tests whether they already damage your liver or have an effect on the amount of leukocytes and erythrocytes.
• Bisphosphonates, for example Actonelor Fosamax, may slow down bone loss. They are used to treat advanced stage of cancers that have invaded the bones. In this stage, bones are often weakened and you may have higher risk of fractures. The breakdown of bone cells may also make the pain more severe. Bisphosphonates can relieve the pain and make fractures less likely to happen. However, bisphosphonates can cause a few gastrointestinal disorders, such as gastric ulcers, esophageal ulcer, and esophagitis.
• Radiopharmaceuticals are injected to the vein, accumulate in bone tissues and emit radiation that wipes out cancer cells while significantly relieving pain. Strontium Chloride with Sr-89 isotope is the most likely radiopharmaceutical for treating bone cancer.
Unfortunately, drugs may not always be able to defeat cancer pain. In this case, the only way to reduce pain is by shrinking the tumor size. Radiation is usually the primary choice. Additionally, implanted pumps or nerve blocks may help in relieving pain. When a tumor becomes too large and cause excruciating pain, surgery is often the best option.