Pain Management

It is possible to manage pain effectively in most people with cancer or with a history of cancer. Although cancer-related pain cannot always be relieved completely, therapy can lessen pain for nearly all people with cancer. Effective management of pain and other symptoms improves quality of life throughout all stages of the disease.

No one should hesitate in telling their doctors or nurses if they are feeling pain. In fact, pain can interfere with the effectiveness of cancer treatment, so it is very important that members of a care team know about any pain that their patients may be experiencing.

Assessment of Pain

The diagnosis, stage of disease, response to pain and treatments, and personal likes and dislikes are different for each person. Because of that, management of cancer pain at ACH is tailored to the individual in order to be as effective as possible.

All ACH  patients are regularly screened for the presence of pain in both the hospital and outpatient settings. Patients in the hospital are asked every four hours if they have pain. They are encouraged to report pain to their nurse or doctor whenever it occurs. Intensity is measured on a scale of zero to ten. No pain is rated as a zero. The worst pain imaginable is rated as a ten. Every effort is made to provide relief and ongoing assessment.

Management of Pain

Over the past three decades there have been many scientific advances in understanding and treating pain. Researchers have identified pain receptors and clarified how pain signals are transmitted to the brain. These findings have resulted in more-effective therapies for treating pain in people with cancer.

Cancer-related pain may be treated through one or more of the following approaches:

Removal or Reduction of the Cancer

Surgery, radiation therapy, chemotherapy, and immune therapy may rid the body of some or all of the underlying cancer. This can provide substantial relief from pain. In addition, new minimally invasive treatments can destroy tumors without surgery.

Palliative Surgery or Radiation Therapy

Surgery and radiation therapy can be performed strictly for palliative purposes as well. This means the goal of the surgery is to reduce pain and other symptoms so people with cancer can sustain their quality of life.

Surgery may be used to prevent or control pain-causing cancer complications. These include bowel obstruction, compression of the spinal cord or peripheral nerves, and compression of organs. Palliative surgery and radiation are focused on comfort. They are used primarily for people with advanced cancer.

Pharmacologic and Anesthetic Approaches

Pain-relieving medicines can be prescribed for various types of cancer-related pain. These medications are given in different ways depending on an individual’s needs and preferences.

Delivery methods include:

Typically, a nurse will administer these medications, but patients may do it themselves. In that case, it is called patient-controlled analgesia, or PCA. The patient can determine the amount of pain medication that is given by pressing a button on a computerized pump.

Adjuvant Analgesics

Several drugs besides non-opioids and opioids have been found to provide pain relief in specific situations. Many of these drugs are better known for treating conditions other than pain. They include antidepressants, anticonvulsants, and steroids. These drugs are now are being used with excellent results to manage cancer-related pain. Some of them have been found to help relieve certain types of pain. For example, tingling and burning sensations and pain caused by inflammation (swelling) can be treated by adjuvant analgesics.

Nerve Blocks

For acute and postoperative pain and some chronic pain problems, temporary nerve blocks (neural blockades) can provide short-term relief. In this procedure, a doctor injects a local anesthetic into or around nerves or below the skin in the area where there is pain. The anesthetic interrupts the transmission of pain signals to the brain. This may provide relief for up to several hours.

In a procedure called a neurolytic block (neurolysis), a doctor injects a substance — most often ethyl alcohol or phenol — into a nerve or into the spinal fluid. This destroys the nerve tissue in the pain pathway. This technique usually has a long-lasting or permanent effect.

Epidural and Intrathecal Pumps

Nerve blocks work best for pain that occurs over a limited area. Generally, this involves one or two specific nerves. For pain that is more widespread, it is possible to interrupt pain signals using epidural or intrathecal pumps. (“Epidural” refers to the space just outside the spinal cord’s outer membrane. “Intrathecal” refers to the space between the sheaths covering the spinal cord.) These pumps are either carried in a pouch or placed under the skin to deliver medication continuously to broad areas. Some pumps have a button to push to receive additional medication.

By delivering medicine directly to the nerves causing pain, less medication may be needed. For many people, this can mean better pain relief with fewer side effects.

Neurosurgical Approaches

Most cancer-related pain can be effectively managed with medication. When drug therapy does not provide adequate relief or when the side effects of medications become a problem, nonpharmacologic approaches are often effective.

In some instances in which pain is not controlled by more conservative means, pain can be interrupted (ablated) by neurosurgery. The most common procedure is called a cordotomy. It disables the nerves in the spinal cord that are responsible for conducting pain impulses to the brain. Neurosurgical techniques are also sometimes used to implant drug-delivery devices and to stimulate nerve fibers to prevent pain.

Psychological Approaches

Focused psychological care is an important part of effective pain management. Short-term psychotherapy, structured support, and cognitive-behavioral therapy can help people develop useful coping skills. These approaches can further enhance the effectiveness of other treatments. Our doctors and nurses are committed to the psychological care of people with cancer and their families.  We also have counseling services for the problems of coping with cancer.