Cancer Pain Treatment Philadelphia

Pain related to cancer is an unpleasant emotional and sensory experience. With pain management, you do not have to suffer in pain during your treatment. When treated by the right doctor and with the right treatments, pain can be reduced or completely alleviated.

What causes cancer pain?

The cancer itself can cause pain, especially if a tumor is pressing on nerves or organs. In addition, cancer treatment is often painful, such as radiation and chemotherapy. The side effects can be quite devastating. Cancer pain often depends on the stage of the disease, the extent of the illness, and patient’s pain threshold and tolerance, and the type of cancer.

How is pain measured?

There is no test available to measure the various levels of pain. However, the doctor will ask you questions about your pain and have you rate it on a scale. The doctor may use visual aids to assess your pain.

What types of symptoms are associated with cancer pain?

Pain can be:

  • Dull – Weak or slow
  • Throbbing – Like a heartbeat
  • Sharp – Intense and knife-like
  • Steady – Continuous and does not change in intensity

What causes cancer pain?

This type of pain can be from:

  • Side effects to surgery, chemotherapy, and/or radiation therapy
  • A tumor that presses on a bone, organ, or nerves
  • Poor blood circulation
  • Blockage of a body canal or organ
  • Inflammation or infection
  • Stiffness related to inactivity
  • Psychological responses due to anxiety, depression, or tension

How common is cancer pain?

Studies show that as many as 90% of people with advanced cancer experience severe pain. In addition, 30% of all cancer patients have pain. The most common cause of cancer pain is from tumors that metastasize to the bone.

What types of medicines are used for cancer pain?

The type of medication prescribed will depend on the severity of the pain, the type of cancer, and the patient’s tolerance to medications. Sometimes, a combination of drugs are used for cancer pain. Options include:

  • Antidepressants – Amitriptyline and nortriptyline are examples of this class of drugs.
  • Anticonvulsants – These include carbamazepine and gabapentin.
  • Narcotics – These agents include hydromorphone, oxycodone, codeine, hydrocodone, and fentanyl.
  • Topical agents – These include pain patches, such as Lidoderm, as well as capsaicin.

What treatment options are available for cancer pain control?

There are several treatments used in conjunction with medications that help cancer pain. Treatments include:

  • Nerve block – Depending on the location of the pain, the doctor can use a long-acting anesthetic onto the targeted nerves to “block” the pain signal transmission. This involves insertion of tiny needles into the back using x-ray guidance.
  • Patient-controlled analgesia (PCA) – The pump allows the patient to administer the pain medication when pain occurs. The patient controls the frequency and amount of the pain.
  • Celiac plexus block and neurolysis – These procedures are used for abdominal and pelvic cancers. The doctor first uses an anesthetic, which is injected onto the celiac plexus nerves that supply the abdomen. If this works, the doctor can instill phenol or alcohol, which are neurolytic agents. According to a recent study, the block has a 90% success rate.
  • Superior hypogastric plexus block – This block is used on the superior hypogastric nerves, which supply the abdomen and pelvic regions. The doctor will insert small needles through the back using x-ray guidance, and inject a long-acting anesthetic. A recent clinical study found that 72% of patients reported pain relief with this block, and they remained pain-free for six months.

Resources

Kaufman M, Singh G, Das S, Concha-Parra R, Erber J, Micames C, & Gress F. (2010). Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastrology, 44:127–134.

McGreevy K, Hurley RW, Erdek MA, Aner MM, Li S, & Cohen SP (2013).The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Practice,13, 89–95.

Plancarte R, de Leon-Casasola OA, El-Helealy M, et al.(1997). Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesthesia, 22:562-568.