Pain & Palliative Care

  • Cancer Pain
  • Palliative care

Causes of Cancer Pain

Most cancer pain is caused by the tumour pressing on bones, nerves or other organs in your body. Sometimes pain is related to your cancer treatment.

Remember that some pain may have nothing to do with your cancer. You may have the general aches and pains that everyone gets from time to time.

Types of Cancer Pain

Cancer pain can be acute or chronic. Acute pain is due to damage caused by an injury and tends to only last a short time.

Chronic pain is pain caused by changes to nerves. Nerve changes may occur due to cancer pressing on nerves or due to chemicals produced by a tumour. It can also be caused by nerve changes due to cancer treatment.

The amount of pain you have with cancer depends on

  • The type of cancer you have
  • Where it is
  • The stage of your cancer
  • Whether the cancer or treatment has damaged any nerves
  • Other factors such as fear, anxiety, depression and a lack of sleep

If you have pain it is very important to let your pain physician know straight away. If you try to put up with the pain, this can lead to nerve changes that may make the pain harder to control in the future

Cancer Pain Treatment

Oral Medications: Pain killing drugs work to control cancer pain in most people. The key to controlling cancer pain is to take your medicine on a regular schedule. Do not wait until your pain gets bad. Pain is easier to control when you treat it just after it starts. Be careful when taking nonprescription medicines. Talk with a pain physician before you take these medicines, especially if you have a fever or have had kidney or liver disease, gastrointestinal bleeding, or a stomach ulcer.

Nerve Blocks: Nerve blocks are injections containing potent anti-inflammatory agents directed at a particular nerve or nerve group that is intended to reduce inflammation and relieve pain.

Intracthecal Pump: Also called infusion pain pumps or spinal drug delivery systems. In this procedure, a pocket is made under the skin that’s large enough to hold a medicine pump. The pump is usually about one inch thick and three inches wide. A catheter is also inserted, which carries pain medicine from the pump to the intrathecal space around the spinal cord. The implants deliver medicines directly to the spinal cord, where pain signals travel. For this reason, intrathecal drug delivery can provide significant pain control with a fraction of the dose that would be required with pills. In addition, the system can cause fewer side effects than oral medications because less medicine is required to control pain.

Radiofrequency Ablation: Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. RFA can be used to help patients with chronic (long-lasting) cancer pain. RFA has proven to be a safe and effective way to treat some forms of pain. It is generally well-tolerated, with very few associated complications.

Neurolytic Blocks: Neurolytic blocks refer to the blocks in which the target nerves are lysed (undergo change in structure) by injecting neurolytic agents. The commonly used neurolytic agents include absolute alcohol, phenol, glycerol. The neurolytic blocks are commonly given in cancer pain such as pancreatic cancer, bowel cancer, pelvic malignancy, oral cancer and non-cancer pains such as trigeminal neuralgia. There is a chance of alcohol induced neuritis after administration of neurolytic blocks.

What is Opioids?

Opioids, sometimes called narcotics, are medications prescribed by doctors to treat persistent or severe pain. They are used by people with chronic headaches and backaches, experiencing severe pain associated with cancer and by adults and children who have gotten hurt playing sports or who have been seriously injured in falls, auto accidents or other incidents.

Mythe of Opioids

What are the myths about using opioids to treat cancer pain?

Many patients are reluctant to use opioids such as morphine, oxycodon, fentanyl, buprenorphine or methadon. These drugs should, of course, only be used in cases of severe pain and they do have side effects.

However, the fear of using opioids is very often based on prejudice or myths, such as:

  • Opioids are addictive!!
    Not true: if you do not use more than you need to treat the pain, you will not become addicted.
  • Once you start using opioids, your days are over!!
    Not true: strong painkillers are used to treat severe pain. If the pain decreases, for example, because treatment of the cancer is successful, you can reduce the morphine dosage in consultation with your doctor.
  • Using opioids means you have entered the final stage of a disease!!
    Not true: morphine is simply a very effective painkiller that is used to treat severe pain, irrespective of the duration or severity of your disease.
  • It is best to take as few painkillers as possible!!
    Not true: of course you should never use too many painkillers. But you should remember that pain can often be worse for you than painkillers.
  • Only take painkillers when you start to feel the pain!!
    Not true: you should take painkillers at regular intervals in order to achieve basic pain relief. If you wait until the pain starts, you will be too late and will not achieve effective pain relief.
  • Opioids can cause apnoea!!
    Not true: if you only take what painkillers are necessary to treat your pain, you will not suffer from apnoea.

Palliative care (or supportive care) is care that focuses on relieving symptoms caused by serious illnesses like cancer.

It can be given at any point during a person’s illness to help them feel more comfortable.

What is palliative care?

Palliative care is care for adults and children with serious illness that focuses on relieving suffering and improving quality of life for patients and their families, but is not intended to cure the disease itself and should be provided along with curative treatment.

Palliative care focuses on helping people get relief from symptoms caused by serious illness – like nausea, pain, fatigue, or shortness of breath.

In the past, the term palliative care was mainly used to describe the act of promoting comfort when aggressive treatment was no longer working – the care given at the end of life.

recently, it’s getting much more attention and study. It has grown into a specialized field of knowledge as well as being a standard part of care given by doctors and cancer care teams.

Palliative care is given throughout the cancer experience, whenever the person is having symptoms that need to be controlled. This can be from the time of diagnosis until the end of life.

Palliative care is also about giving patients options and having them take part in decisions about their care.

It’s about assuring that all their care needs are addressed – their physical, emotional, spiritual, and social needs.

Why Do We Need Palliative Care ?

Estimated 34 million people need PC in the country. 75% of 8lakh new cancer cases per year are diagnosed at a very late stage at that point treatment is unlikely to be of value in preventing disease progression.

1.6 million people per year experience cancer pain but less than 3% have access to adequate pain relief. It results in patients dying UNDIGNIFIED AND AGONIZING DEATHS.

"At some stage, cancer may not be treatable but cancer pain can be adequately controlled" Don't suffer from Cancer Pain!!

Benefits of palliative care

Palliative care may also increase survival. A 2010 study of lung cancer looked at patients who were given palliative care alongside cancer treatment.

The patients who received palliative care along with cancer treatment lived nearly 3 months longer than the patients who received the cancer treatment without the palliative care.

Who should get palliative care and when?

Any person diagnosed with a serious illness who is having symptoms should get palliative care like

Cancer Patients Terminally ill patients with endstage heart failure, endstage renal failure Progressive neurological diseases like motor neurone disease, Multiple sclerosis Spinal cord injury with permanent bedridden patients Stroke with bedridden and permanently disabled person Dementia Elderly patients Patients with HIV and AIDS

By the concept of PC we can provide physical, psychological, emotional and spiritual care, all togather it is holistic care.

Death is a natural process and we do not shorten or unnecessarily prolong the life. Primary aim is to reduce suffering by doing pain management and symptom management.

Who delivers palliative care?

This “palliative care team” typically includes a palliative care doctor (who may be board-certified in Hospice and Palliative Medicine), a palliative care nurse, social worker, patient navigator, and maybe a person with a spiritual role such as a pastoral counselor or chaplain.

Many hospitals and oncology clinics have these teams as part of the services they provide. They can send the team to patients in intensive care units, emergency rooms, or hospital wards to talk with the patient and family and help with palliative care.