Cancer Pain Treatment
Pain often affects people diagnosed with cancer, although not everyone diagnosed with cancer will have pain. Individuals who have been diagnosed with advanced cancer (cancer that has spread to other areas of the body) are more likely to experience severe cancer pain.
Cancer pain is different for each individual: it can be dull and achy, or sharp and burning, and can be constant, irregular, mild, or severe. If you’ve been diagnosed with cancer, and you experience pain, it’s important to tell your doctor. Cancer pain is very treatable.
The aim of cancer pain treatment is to relieve pain caused by cancer, or by cancer treatment, to help improve quality of life. Although pain cannot always be completely eliminated, it can be controlled, which helps patients get through treatment more comfortably. At Specialist Pain International Clinic, we work with each patient to provide personalized cancer pain treatment. Singapore pain specialists at our clinic provide tailored cancer pain treatment plans, developed for each patient’s unique situation. These treatment plans are based on the diagnosis, age, and personal preferences of the individual.
What Causes Cancer Pain?
Cancer pain can manifest for a variety of reasons:
The cancer itself — When cancer starts to grow, it can place pressure on and harm surrounding tissues and organs, causing pain. For example, a tumor near the spine can press into nerves in the spinal cord.
Cancer treatment — Sometimes cancer treatments, such as surgery and chemotherapy, can cause pain.
Diagnostics tests — Certain tests used to diagnose cancer and monitor the effectiveness of the treatment can cause pain.
When To See A Doctor For Cancer Pain Treatment?
Make an appointment to see your cancer care team or a pain specialist if you begin to experience:
- New pain
- An increase in your current pain levels
- Trouble sleeping
- Pain that does not improve when treated
What To Expect During Your Appointment?
When meeting with your doctor, he/she will ask you to locate and describe the pain. If you can, it might be helpful to keep a journal of how you feel until you see your doctor. Write down the intensity of the pain, how often you’re in pain, and what the pain feels like (dull and achy, or sharp and burning?). If you decide to try over-the-counter pain medications or hot or cold packs to reduce your pain, make a note as to whether you found relief and share this with your doctor.
You will discuss treatment options with your doctor, which will vary depending on certain factors, such as your:
- Specific diagnosis
- Age
- Cancer treatment plan
- Overall health
What Does Cancer Pain Treatment Involve?
Cancer pain treatment typically involves oral medications to try and relieve pain symptoms. If over-the-counter pain medications do not help control your pain, your doctor may prescribe:
- Nerve medications as more than 50% of cancer pain will be worsened by nerve pain
- Opioid pain medication
- Steroids for pain caused by swelling
- Injections to focus pain medication in the affected area
- Injections in the spine to block pain signals from reaching the affected nerve
- Implants to deliver pain medications to the site of pain continuously, reducing the need for frequent oral medication
What is an Intrathecal Implantable Pump?
An Intrathecal Morphine Pump is a special implantable device that delivers continuous small amounts of Morphine into the spinal cord area via a small tube (catheter). See Figure 1. It is an effective treatment of severe cancer pain because the drug is delivered directly to the pain area. Your symptoms can be better controlled with a much smaller dose as compared to oral medication. Thus reducing the side effects of medication.
When is an Intrathecal Pump used?
An Intrathecal Morphine Pump is used for severe cancer pain treatment. Cancer pain is a kind of pain that does not respond to other pain treatment methods.
Where is the tubing (catheter) and pump inserted?
The tubing is inserted in the midline at the lower back. The pump is implanted on the abdominal wall. The pump is a round metal device about the size of a hockey puck that is surgically implanted beneath the skin of your abdomen. A small plastic tube, called a catheter, is surgically placed in the intrathecal space of the spine and is connected to the pump (Fig. 1). A space inside the pump called the reservoir holds the medication. The pump is programmed to slowly release medication over a period of time. It can also be programmed to release different amounts of medication at different times of the day, depending on your changing needs. The pump stores the information about your prescription in its memory, and your doctor can easily review this information with the programmer. When the reservoir is empty, the doctor or nurse refills the pump by inserting a needle through your skin and into the fill port on top of the reservoir.
Figure 1. The intrathecal pump system consists of a pump/reservoir implanted between the muscle and skin of your abdomen and a catheter that carries pain medication (blue area) from the pump to the spinal cord and nerves.
What happens during the placement of the Intrathecal Pump?
First, you are admitted to the hospital for placement of a spinal catheter. A catheter is first inserted into the spinal column under local anesthesia. The implantable pump is then surgically inserted beneath the skin of your abdomen.
What are the precautions after the pump insertion?
- Take the pain medications as directed by your doctor.
- Drink lots of water and eat high-fibre foods. Laxatives and stool softeners such as Dulcolax, Senokot, Colace, and Milk of Magnesia are available without a prescription.
- Ice your incision 3-4 times per day for 15-20 minutes to reduce pain and swelling.
- Spinal headaches may be caused by leakage of cerebrospinal fluid around the catheter site. The leak often heals on its own. Lie flat and drink plenty of caffeinated non-carbonated fluids (tea, coffee).
Restrictions
- Do not bend, lift, twist your back or reach overhead for the next 6 weeks. This is to prevent the catheter from moving out of place until it heals.
- Do not lift anything heavier than 5 pounds for 2 weeks after surgery.
- No strenuous activity for the next 2 weeks including yard work, housework and sex.
- Avoid straining when having a bowel movement.
- Do not drive until your follow-up appointment. You may ride in a car for short distances of 45 minutes or less if necessary.
- Do not drink alcohol for 2 weeks after surgery or while you are taking narcotic medication.
Activity
- Avoid sitting for long periods of time.
- Get up and walk 5-10 minutes every 3-4 hours. Gradually increase your walking time, as you are able.
Bathing/Incision Care
- Wash your hands thoroughly before and after cleaning your incision to prevent infection.
- Do not submerge or soak the incision in water (bath, pool or tub).
- Do not apply any lotions or ointments over the incision except what is provided by your doctor.
- Some drainage from the incision is normal.
How long does the pump last?
The pump will need to be refilled at least every 3 months. This is done by inserting a needle through the abdominal wall. The batteries in the pump last from about 5 years. This depends upon the usage. At that time the pump will need to be replaced as the batteries cannot be replaced.
What are the advantages of using the Intrathecal Morphine Pump?
This severe cancer pain treatment improves pain control due to the continuous delivery of the medicine into spinal cord. There are less side effects as the medicine is given in smaller doses. It is a safer way to control pain than some of the other options available.
What are the possible complications?
- Bleeding
- Infection
- Pump malfunction
- Neurological injury
Living with an intrathecal pump
You must schedule medication refills on a regular basis with your doctor. At your refill appointment, the effectiveness of your severe cancer pain treatment will be assessed and your pump will be adjusted accordingly. The goal is to find the optimal amount of pain or spasticity control while having minimal side effects. You should tell your doctor if you experience unusual symptoms, drug overdose, or feel that your dosage is ineffective. You may need to take supplemental oral medicine if you have periods of stronger pain.
Just like a cardiac pacemaker, other devices such as cellular phones, pagers, microwaves, security doors, and anti theft sensors will not affect your pump. Be sure to carry your Implanted Device Identification card when flying.
Severe Cancer Pain Treatment
Sometimes, cancer pain may inhibit you from going to work, or even getting dressed in the morning. This is referred to as severe cancer pain. Treatment for severe cancer pain typically includes more than one medication or treatment type. This is because chronic severe pain can sometimes be accompanied by breakthrough pain. Breakthrough pain refers to pain that occurs suddenly and is not controlled by your normal treatment. If you experience breakthrough pain, your doctor will most likely prescribe you a second medication to be used in the event of a flare-up.
Managing Cancer Pain Treatment at Home
Your cancer pain treatment plan is designed to meet your specific pain needs. For this reason, it’s important to take your pain medication exactly as it has been prescribed to you by your doctor. Pain that is not properly treated can become chronic or long-term.
If you notice that your medication no longer provides you with pain relief or the same pain relief you experienced when you first started treatment, call your doctor. He/she can work with you to make appropriate changes to your cancer pain treatment plan.
Sources:
https://www.cancer.gov/Common/PopUps/popDefinition.aspx?id=478743&version=patient&language=English&dictionary=Cancer.gov
https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-pdq
https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-pain/art-20045118
https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/facts-about-cancer-pain.html
https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/pain/pain.html
https://www.cancer.net/navigating-cancer-care/how-cancer-treated/when-call-doctor-during-cancer-treatment
https://www.mdanderson.org/patients-family/diagnosis-treatment/emotional-physical-effects/cancer-pain-management.html
https://www.webmd.com/cancer/cancer-pain-what-helps#2
https://my.clevelandclinic.org/health/treatments/15840-transcutaneous-electrical-nerve-stimulation-tens