Pain is one of the common symptoms and complications of cancer that can be exacerbated by depression and anxiety due to illness and…. Pain control for cancer patients is one of the most important issues for physicians, patients and their families, but cancer progression is not necessarily associated with pain and its control is achievable by pain control methods. Pain control regulates sleep rhythm, which improves the quality of life of the patient.
The mechanism of cancer pain:
Neuropathic : Pain caused by damage to nerve fibers chemically, mechanically and thermally.
Nociceptive Pain : Pain caused by irritation of the nerves and organs due to the secretion of substances that cause them damage.
Visceral Pains : Pain caused by the involvement of the sympathetic nervous system and internal body tissues.
Somatic Pain : Causes localized damage to a body organ.
Bone pain : Pain that results from a tumor attack or chemotherapy or loss of bone marrow hematopoiesis.
Cancer Pain Treatment:
Pain control improves the quality of life of patients. Methods of pain control in cancer patients vary according to the symptoms and severity of the problems. The therapies are step-by-step, ranging from simpler, cheaper drugs to more advanced interventional methods. In some cases it is not possible to completely relieve the pain, but using a combination of techniques can reduce the pain and make it more tolerable.
Methods of treating cancer pain
Pharmacological treatment of cancer pain
Acute pain in cancer occurs due to stimulation of pain receptors, but chronic pain is caused by damage to nerve cells. There are specific drug groups to treat each of these two types of pain. Cancer pains are a combination of both types of pain so both problems need to be treated. The most common oral medications used in cancer patients, depending on the stage and extent of the pain, are simple analgesics, non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, steroids, and opiates, which comply with WHO guidelines. This is called step-by-step pain relief.
Interventional methods of treating cancer pain:
Nerve block :
This treatment is performed without anesthesia in the operating room with a fluoroscope in sterile conditions and with local anesthesia by a pain specialist. Prevention of nerve activity is done by injecting the drug with topical anesthetic. In this way, the abnormal electrical charge of the nerves is blocked to control the patient’s pain.
This is also called a nerve block, in which the transmission of pain messages to the spinal cord and brain is blocked and the pain is reduced, and therefore pain can be better controlled than medication. In this method of treatment, first to make sure which nerve is transmitting the pain message, the target nerve is first blocked , the function of the target region is temporarily blocked by the drug and after obtaining the appropriate therapeutic response and pain relief. Long-term pain control pulses of neurolytic drugs (phenol, alcohol, etc.) or thermal radiofrequency are used. In cases of pain after pain control we may have recurrent pain in the months or years to come, for example in a rapidly growing tumor, it may later affect another neural network and cause it to return. Unfortunately, as cancer has to be fought on a continuous basis, its pain is also reduced, with the rate of disease progressing.
Splenic &ceiliac nerve block
This block is an effective method of treating chronic abdominal pain caused by cancer or pancreatic inflammation. The splenic nerve on both sides of the spine transmits pain signals from the various abdominal organs to the brain. The celiac neural network is located at the bottom of the splenic nerve. Blocking the celiac neural network by injecting topical anesthetics is used to reduce post-inflammatory or pancreatic cancer and other upper-abdominal gastrointestinal pain.
Intrathecal Pump :
By surgery, it is possible to place devices in the body to enter the body or stimulate the nerves. In the advanced stages, due to the involvement of different neural complexes, pain control may not be achieved by blocking one or two neural networks, so more advanced techniques should be used to control pain, one of which is intrathecal pumps such as catheters. Thinly inserted into the spinal cord or epidural space, it attaches to a permanent subcutaneous pump through which morphine and other medicinal ingredients are injected, and these drugs stop the transmission of pain messages by directly affecting the spinal cord. And the pain is not transmitted to the higher nerve centers and the patient does not notice the pain and is fully disappears.
Of course, reducing pain in this way has more complications and costs and requires more care, experience, and training for my patient. Alternatively, spinal cord batteries can be used to control pain as described elsewhere.
Pain treatment with tumor radiofrequency destruction :
In this treatment, the tumor is heated and destroyed by a needle electrode. This reduces pain significantly in patients with cancer spread to the bone.