Introduction:
Pain is a very subjective and disturbing sensation to any person. One of the prominent medicine textbooks describes pain as an unpleasant sensation localized to any body part. Pain is one symptom that has been reported differently by various individuals. Some describe it as sharpshooting, and 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 an irritation of the different types of nerves responsible for pain sensation, just like different taste sensations, such as sweet, salt, and bitter. Individuals have different pain sensations depending on the nerves stimulated. Unfortunately, they often underestimate this bothersome symptom and focus so much on the primary treatment.
What Causes Cancer Pain?
Pain in cancer is because of the growth and distribution of the tumor into the adjacent tissues. As the tumor size increases, it presses on vital structures, such as nerves, bones, and other essential organs. In addition, the cancerous growth can release chemicals causing pain. Although treating cancer helps alleviate pain, specific treatments, such as radiation therapy, chemotherapy, and surgery, may also cause pain.
What Are the Types of Cancer Pain?
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Nerve Pain: It commonly occurs due to pressure or nerve damage by the cancerous growth. Also, radiotherapy and chemotherapy can cause nerve pain.
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Bone Pain: It is a dull and throbbing pain that occurs due to the spread of cancer into the bony tissues. It can involve a specific area of a bone or the adjacent bones.
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Soft Tissue Pain: It is a sharp pain that is easy to locate, as it damages specific organs or muscles.
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Phantom Pain: It is found to be the unbearable pain that the patient reports when a part is surgically removed. For example, pain in the breast area after its removal.
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Referred Pain: It is a type of pain originating from an area that refers to other areas of the body. For example, a swollen liver can cause pain in the shoulder.
How to Treat Cancer Pain?
It is crucial to understand the nature and cause of pain to address pain, especially in cancer patients. It is called somatic pain if there is an organic cause, which means the pain can be attributed to an abnormality or disease in the body. As a result, this pain is much better controlled. Options for managing this type of pain are various painkillers having different mechanisms of action, radiation therapy, and nerve block.
Painkillers: The painkillers usually prescribed are according to a step ladder pattern recommended by WHO (World Health Organization). First, 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 or 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 a crucial distress signal in the body, and one 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: Radiation therapy is another method of controlling pain. Usually, it takes a week or two to show 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. However, multiple studies and evidence support that radiation controls pain for longer. Radiation therapy delivered in such cases is usually in a single sitting, five sittings, or ten. Each sitting is usually not more than 10 minutes, where the patients lie still, and the machine does the rest. Often when radiation is delivered, the patient is asked to continue their painkiller medications for two weeks.
Nerve Block: The nerve block is another alternative when the above methods fail, in such cases, by accurately identifying the nerve 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 for at least a day.
Surgery: The surgical removal of the tumor is recommended when a nerve, soft tissue, or any organ is invaded by the increased tumor size, causing pain.
What Are the Alternative or Complementary Treatments for Cancer Pain?
Certain types of cancer discomfort or unpleasant side effects from cancer treatments may be lessened by therapies including acupuncture and hypnosis. These therapies do not take the place of medical cancer pain management. One should consult a medical professional before beginning any complementary or alternative cancer pain relief.
What Are Some At-Home Options for Managing Cancer Pain?
Applying cold or heat can alleviate cancer pain:
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Apply Heat: Heating pads and warm packs can promote circulation, lessen muscle spasms, and increase comfort. Avoid applying heat in areas where radiation therapy is given. Also, one must refrain from applying warm packs in tumor areas.
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Apply Cold: Cold packs can relieve pain and inflammation in the nerves. Cold packs should be covered with clothes before applying.
How Else Can Pain From Cancer Be Handled?
While medication is the usual treatment for cancer pain, further pain relief may be obtained via radiation therapy or surgery to remove or shrink a tumor. Physicians typically use analgesics, which are painkillers, or non-pharmacological therapies including physical therapy, rehabilitation, biofeedback, imaging, and relaxation methods to treat cancer pain.
When Should One Contact a Medical Professional About Adverse Effects From Painkillers or Cancer Pain?
It might be difficult to manage cancer pain. One should reach a physician if -
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One is experiencing acute pain. Medicines prescribed by the physician are not working effectively against acute pain.
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One experiences pain after taking pain medications as prescribed.
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The adverse effects of cancer painkillers are more severe than anticipated.
Why Are People Not Receiving Treatment for Cancer Pain?
Cancer pain is often neglected and left untreated. The common factors are:
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Doctors' Reluctance: Patients with cancer are often not asked about the pain associated with it. Concerned about opioid administration and abuse, many doctors are reluctant to treat cancer pain. In case of doubt, it is better to refer the patient to a pain specialist.
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Patients’ Reluctance: Some patients have the fear that cancer pain is due to the progression to the next stage and do not mention the doctor about pain.
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Fear of Opioids: Most patients fear addiction to opioids. However, opioids do not cause addiction in most people in advanced stages of cancer. Instead, the patients develop tolerance to the drug. In this case, a high drug dose must be administered to alleviate the pain.
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Fear of Side Effects: Some patients fear the adverse effects of pain medications. For example, the patients may fear sleeping too long without communication, acting weird, or being dependent on medicines. However, these symptoms will resolve after the physician identifies the correct dose of the pain drug.
Conclusion:
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 the treatment. In addition, the patient must be made aware and insist on informing the physician at any time about pain symptoms. Therefore, managing the patient is far more critical than treating the reports.
