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Cancer Pain - how does one manage?

Updated: Mar 17

Cancer pain is experienced by 20% - 50% of the cancer patients. Why do patients experience pain from cancer? What are the best ways to manage pain from cancer? Managing cancer pain is a big part of cancer treatment. Cancer patients should clearly communicate to their oncologists about the pain they are experiencing. Communication from patients is the gold standard of accessing pain. Pain management has serious implications on the quality of life of the cancer patients.


Pain pills on the table that came out from a bottle.

PAIN CLASSIFICATION

· Acute

· Chronic

· Breakthrough


· Nociceptive

· Neuropathic

· Psychogenic



DRUGS TO TREAT CANCER PAIN

· NSAIDs (Non-steroidal anti-inflammatory drugs)

· Opioids

· Add-on pain medicines

· Cannabinoids




OTHER OPTIONS

· Massage

· Chiropractic therapy

· Reflexology

· Reiki

· Acupuncture

· Scrambler therapy


Detailed explanation can be found on www.cancer.gov website. You can also read up peer-reviewed journal articles on cancer pain management by visiting www.pubmed.gov. Below I will try to summarize cancer pain and give you a very basic idea of how cancer pain is clinically managed.


BONE PAIN

Bone pain is one of the most common causes of pain when the disease has metastasized. Most patients are prescribed morphine (or other opioids) for pain relief. NSAIDs (non-steroidal anti-inflammatory drugs) and corticosteroids are also prescribed. They are moderately effective and safe. Zoledronic acid or pamidronate or denosumab are used to reduce bone pain (skeletal events) related events. Palliative radiation therapy can cause pain relief and the effect can last up to 6 months. Surgical intervention is another option.


VISCERAL PAIN

Opioids remain the main form of treatment to ease pain from visceral organs, such as bladder, stomach, bowel and ureters. The main source of visceral pain may be hard to locate sometimes.


NEUROPATHIC PAIN

Neuropathic pain is common in cancer patients. Approximately 17% of the cancer patients receive neuropathic pain. Gabapentin is used as a monotherapy to reduce neuropathic pain. Sometimes gabapentin + opioids provide better pain relief within 4-8 days for incontrollable pain. Pregabalin is used to reduce radiation-therapy induced neuropathic pain.


MASTECTOMY RELATED PAIN

Venlafaxine or gabapentin or pregabalin is used with various results in reducing pain from mastectomy.


POST-THORACOTOMY PAIN

Pain that persists after 2 months of thoracotomy. Opioids and non-opioid analgesics are used to manage the pain.


CHEMOTHERAPY-INDUCED PAIN

Duloxetine is the only drug that has been systematically studied. It can help reduce pain from chemotherapy. Gabapentin does not provide any relief from pain caused by chemotherapy. Venlafaxine is used to treat neuropathy from oxaliplatin. Natural products such as acetyl-L-carnitine showed worsening of pain and the worsening persisted up to two years in some patients.


**** If you want comprehensive information on cancer pain management, please check out our website for the report titled "Options To Manage Cancer Pain".


#Cancer #pain #cancerpain #opioids #cannabinoids

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The information here has been summarized from National Cancer Institute. Follow this link if you want more information: https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-hp-pdq#_387_toc

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Author: Anirban Mukherjee, PhD

The author is a cancer scientist from University of Texas at Austin working on developing new drugs to treat and manage chemoresistant forms of cancer.

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