Understanding Cancer Pain
There are many reasons that a person with cancer can experience pain. Correctly identifying the source of pain is critical to determining the appropriate treatment plan. Pain can be caused by the location of the tumor or structures that the tumor has spread to involve, such as bone. Some procedures performed to diagnose the cancer and surgeries performed to remove the cancer can cause pain. In addition, chemotherapy and radiation treatment can cause peripheral neuropathy, mucositis, and radiation-induced skin burns, sores, and scarring.
It is also important to assess the frequency and quality of the pain. Continuous aching pain may require different treatment than intermittent episodes of pain.
Opioid pain medications are commonly used in the treatment of cancer pain. They can typically be classified as short-acting, long-acting, and rescue opioids. Most patients are initially prescribed short-acting opioids. These medications are intended to treat episodes of pain for 4-6 hours. When the episodes become more frequent or nearly constant, then consideration should be given to starting a time-released or long-acting opioid that can help improve your baseline pain level. For people that continue to have episodes of severe pain despite around-the-clock opioid therapy, termed breakthrough cancer pain, your provider may evaluate the appropriateness of a fast-acting rescue opioid to treat these episodes.
Cancer pain is frequently complex and there can be multiple reasons for pain. As such, optimal pain control typically involves incorporating additional medications to your regimen in addition to opioids. In some cases, these non-opioid medications may be preferable or may help avoid opioid therapy altogether. Neuropathic medications, such as Gabapentin and Pregabalin, can be particularly effective in treating cancer pain. Muscle spasms can accompany pain flares and muscle relaxants can be appropriate for the management of spasms or cramping. Acetaminophen and non-steroidal anti-inflammatory drugs can help reduce the need for opioid pain medication as well.
Vertebral Augmentation for Compression Fractures
When a tumor spreads from its primary location, the vertebral body of the spine is a common location for which this spread can occur. When the cancer weakens the vertebral bone, it can collapse and a pathological fracture occurs. This fracture can be identified through x-ray, CT, PET, or MRI imaging. Under certain circumstances, the pain from a pathological compression fracture can be successfully treated with vertebral cement augmentation. Depending on the specific method for delivering the cement to treat the fracture, this is also called vertebroplasty or kyphoplasty.
Targeted Drug Delivery
Advanced cases of cancer pain may not be adequately controlled with conventional medication management. For these people, targeted drug delivery can be an effective means of controlling their pain. Implantation of an intrathecal pain pump provides a means for the targeted delivery of opioid and non-opioid medication directly to the intrathecal space, spinal cord, and spinal nerve roots. By utilizing this delivery mechanism, it can be possible to attain superior pain control and quality of life compared to conventional treatment.