Cancer pain affects a third of patients and up to 10% of survivors, according to Mayo Clinic and the Journal of Clinical Oncology.
Pain can result from the cancer itself, treatment to fight the cancer, or from surgery required to remove the growth. Cancer is a complex disease, and treating it is a similarly complex endeavor.
Each type of cancer—breast, pancreatic, or lung—is different and affects the body in separate ways. Meanwhile, the pain resulting from treatment depends on the stage of the disease and the type of treatment being used.
Treating cancer pain in survivors presents additional difficulties because while opioids are used relatively freely with patients in active treatment, doctors—and patients—are more reluctant to use the powerful and dangerous drugs for long-term use. Fortunately, much research is underway to uncover more effective ways of helping patients manage cancer pain and improve their quality of life.
Why does cancer pain occur?
Many patients reporting pain have an advanced-stage disease, with discomfort resulting from a growing tumor compressing nerves, organs, bones, or otherwise affecting surrounding tissue. In addition to pain resulting from tumor growth, cancer pain may also result from substances produced by the cells or as a side effect of treatment, including chemotherapy or radiation.
In survivors, cancer pain may develop because of nerves that were severed during surgery. This is common in breast cancer survivors.
Cancer pain manifests in the body through a variety of sensations, but can include a dull ache, sharp jab, or continuous pain. The pain may be constant, or it may come and go.
How is cancer pain treated?
Treatment options vary depending on the type of pain and its cause. Medication, including over-the-counter or prescription medications, is one of the most common methods of treating cancer pain. Pills may be taken orally, but patients sometimes receive the drugs intravenously, particularly if they’re in the hospital.
Other forms of managing cancer pain while in treatment include lifestyle interventions, such as relaxation techniques, efforts at finding humor in the situation, and meditation.
Unfortunately, cancer pain is undertreated, according to Mayo Clinic. Patients sometimes fear reporting pain because they believe it signals disease progression, or they may not wish to take strong medications because they’re worried about becoming addicted or losing mental clarity.
Emerging treatments and technologies look to reduce cancer pain.
Survivors often have to cast a wide net when looking for long-term solutions to cancer pain. Dr. Esme Finlay, a researcher at the University of New Mexico Cancer Center, says:
“In my practice, I often need to use very strong pain medications to get people through their treatment… Sometimes that means [using] opioid pain medicines. But we don’t want people to be on strong opioids for a long time if they don’t need them.”
Finlay was part of the paper that was published in the Journal of Clinical Oncology in an effort to raise awareness of the prevalence of cancer pain among survivors and urge them to get treatment.
It’s important for patients to know their pain can be treated, researchers say, and to seek either a primary care doctor with good knowledge of treating chronic pain or find an interdisciplinary pain clinic with access to alternative therapies such as acupuncture, cognitive behavioral therapy, massage, and physical therapy.
Pain clinics also have access to treatments that primary care doctors don’t, including nerve blocks and injections designed specially to alleviate difficult-to-treat chronic pain. Finlay adds:
“We need to help cancer survivors be functional, active participants in their lives post-treatment.”
Fortunately, research underway seeks to identify new treatments for cancer pain. Some new techniques are modernized versions of older ones. Take, for example, electroacupuncture (EA). The treatment involves traditional acupuncture needles that are used to conduct a light electrical current.
A study completed at the University of Pennsylvania found EA reduced joint pain by 50% in breast cancer survivors taking aromatase inhibitors (AI), which are used to prevent recurrence in post-menopausal women.
Managing joint pain for these women is critical because it not only affects their quality of life, but also increases the risk that they will stop taking the medication prematurely. Patients who don’t complete the full course of medicine have a greater risk of dying from breast cancer or other cause, according to the study.
In the study, women receiving EA not only experienced less cancer pain, but also less anxiety, fatigue, and depression, which are also common complaints of cancer survivors in general and those taking AIs.
Electroacupuncture has also been shown to alleviate stomach and back pain related to pancreatic cancer, according to a study published in the journal Pancreatology.
New ultrasound technology shows promise in the fight against cancer pain.
Other times, debilitating cancer pain results from tumors that have metastasized to the bone. These patients often have limited options for treating the pain, however research published in the Journal of the National Cancer Institute shows that a special ultrasound shows promise for alleviating discomfort.
The treatment is called magnetic resonance guided focused ultrasound (MRgFUS), and it has traditionally been used to help women manage pain from uterine fibroids. The study examined its cancer pain relieving effects on 147 patients, who were given either MRgFUS or a placebo treatment.
The ultrasound therapy involves using ultrasound to heat tumor cells to a temperature between 65 and 85 degrees Celsius, which destroys the cells. MRI is used to guide the ultrasound and make sure it reaches the correct tissue while ensuring the surrounding healthy tissue is not damaged by the heat.
Sixty-four percent of patients reported success, with their cancer pain eliminated or significantly reduced. Many of the subjects were able to reduce or eliminate the use of opioids to treat pain. The ultrasound therapy also worked quickly, with patients reporting an improvement several days after receiving the treatment.
Radiation oncologist Dr. Adam Dicker with Thomas Jefferson University says:
“The work provides cancer patients with more options for treatment of cancer pain and the opportunity for patients to reduce opioid use, which has significant side effects.”
What treatments have you tried for managing cancer pain?
Image by Andreh Santos via Flickr