Pain is a very subjective sensation and the most disturbing sensation to any person. One of the prominent textbooks of medicine describes pain as an unpleasant sensation localized to any part of the body. Pain is one symptom that has been reported differently by various individuals. Some describe it as sharpshooting type, some say it to be of a burning type, while some relate it to be of a nagging kind, and so on. In a simpler context, pain is nothing but an irritation of the different types of nerves which are responsible for pain sensation. Just like we have different types of taste sensation such as sweet, salt, bitter, etc., similarly, we have different pain sensations depending upon the nerves stimulated. We often underestimate this bothersome symptom, which makes the patients' life miserable. Being a cancer specialist, I come across many patients who are in pain, sometimes our focus is so much on the major treatment, that we do not give much importance on controlling this symptom. With experience, I have realized patients are more compliant if their pain is controlled.
To address pain, especially in cancer patients, it is crucial to understand the nature and cause of pain. If there is an organic cause, which means the pain can be attributed to an abnormality or disease in the body, it is called somatic pain. This pain is much better controlled. Options for managing this type of pain are various painkillers having a different mechanism of actions, radiation therapy, and nerve block. The pain killers which are usually prescribed are according to a step ladder pattern recommended by WHO. As per this pattern, the mildest medicine is prescribed, and response is observed, based upon response, further modifications are done such as increasing or reducing the dose, adding another drug having a different mechanism of action so that a combined effect can be observed. Lastly, if these do not work, then opioids like Morphine and analogs can be used. Another approach is giving painkillers when there is pain and not round the clock since pain is an important distress signal in our body, and we should not be suppressing that. However, the prescription of these medicines should be solely at the discretion of the treating registered medical practitioner.
Radiation therapy is another method of controlling pain. Usually, it takes a week or two to have its effect and persists for six months or beyond. The dose and mechanism involved in managing pain by radiation are different from that used to cure the patients. There have been multiple studies and evidence to support that radiation effectively controls pain for a longer duration. Radiation therapy delivered in such cases is usually either in a single sitting, five sitting or 10 sittings. Each sitting is usually of not more than 10 minutes duration where the patients lie still, and the machine does the rest. Often when radiation is delivered patient is asked to continue his or her pain killer medications for two weeks.
Nerve block, is another alternative when above do not succeed, in such cases, by identifying accurately the nerve which is responsible for pain and blocking it with the help of medicines. This is an in-patient procedure done by an anesthesiologist where the patient gets admitted at least for a day.
To summarize, pain is an essential component of patient management, giving the patient a pain-free life is and should always be one of the objectives of their treatment, after all, we manage the patient and not treat their reports.