Cancer pain: treatment

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What is it about ?

Cancer pain is pain related to cancer of any type and at any stage.

This patient guide does not deal with the terminal phase. Indeed, at the terminal stage, a specific approach is most often necessary and planned.

Cancer pain can have different causes:

  • The tumor can compress nearby structures;
  • Pain may be due to metastases;
  • Some pains have no immediate explanation.

The treatment of cancer itself often results in pain relief. If, for example, radiation therapy or chemotherapy causes the tumor to decrease in size, then the surrounding structures are less compressed, which relieves pain.

Pain is treated with medication or with local anesthesia.

What is its frequency?

During cancer treatment, 6 out of 10 patients experience pain. Even after recovery, 1 in 3 patients still have pain. Pain management in three stages (to see further) reduces pain in 7 to 9 out of 10 patients.

How to recognize it?

Pain is a subjective perception. For example, pain of the same intensity may be tolerated well by one person, but not by another.

To “objectify” the pain, it is assigned a score on a scale of 1 to 10. A score of 1 represents the weakest pain, and 10, the maximum pain.

  • A score of 1 to 4 is considered mild pain,
  • A score of 5 to 7, moderate pain,
  • A score of 8 to 10, severe pain.

It is important to describe the type of pain as best as possible:

  • Where exactly did you hurt?
  • Is the pain sharp, dull, gnawing, throbbing, like a burn?
  • Is the pain concentrated in one point, does it form a band, or is it rather extensive and vague …?

This description helps to differentiate between classic pain and pain related to a problem with a nerve (neuropathic pain). The neuropathic pain is stabbing, burning-like, comparable to a toothache.

How is cancer pain treated?

Painkillers

Pain relievers are administered in stages. Since 1986, the World Health Organization (WHO) has recommended a three-step pain scale. Each level determines the type of painkiller to administer.

  • First level: paracetamol and anti-inflammatory drugs. The dose is gradually increased. If that is not enough, we go to the second level.
  • Step two: weak opioids, such as codeine and tramadol, whether or not associated with paracetamol and anti-inflammatory drugs. If that is still not enough, we go to the third level.
  • Third tier: strong opioids, such as morphine, hydromorphone, oxycodone, fentanyl and buprenorphine. These powerful drugs can also be given in combination with paracetamol and anti-inflammatory drugs. However, they cannot be combined with weak opioids. These should be stopped before giving strong opioids.
    • The morphine remains the drug of first choice. It is preferred in the form of a syrup or in tablets. Injections should be avoided. They are often relatively painful because the patient, due to his thinness, has very little muscle tissue.
    • the fentanyl : exists as a patch. It is a good alternative for patients who can no longer take oral medications. In principle, the patches are replaced every 3 days. In case of extreme weight loss, absorption is faster, and the patches should be renewed every 2 days.
    • In the terminal phase, we often opt for subcutaneous infusion, which allows the administration of different drugs and brings the patient into a state of light sleep (palliative sedation).

If needed, you can switch from one drug to another. For pain relief, both a long-acting and a long-acting drug and a short-acting drug are always given. The long-acting drug forms the basis of treatment. The short-acting drug is used during pain peaks (intercurrent pain). Intercurrent pain is transient pain that is more intense than the background pain that is present continuously. These pains come on suddenly, are severe and go away quickly, often within 30 minutes. Intercurrent pain can be triggered, for example during certain movements, or occur spontaneously, for no reason.

Adjuvant therapy

Sometimes we also opt for drugs that are not really painkillers, but can still relieve pain because they act on the nervous system. This is called adjuvant therapy. These include, for example, antidepressants and antiepileptics, which can relieve neuropathic pain.

Cortisone

Cortisone is used in the treatment of pain caused by the size of the tumor, for example in the brain, bones, liver … Tumors often retain fluid, the accumulation of which causes edema. Cortisone reduces this accumulation of fluid, and the tumor shrinks in size; therefore, the compression decreases. In addition, cortisone has a euphoric effect, which can help with fatigue, appetite disturbances, etc.

Radiotherapy

Metastases in the bones can be very painful. Radiation therapy is the best option for treating metastases. Usually, it takes place in one sitting.

What can you do ?

Try as best you can to determine the severity of the pain, describe how it has progressed, and talk about the side effects of the treatment. Open communication about this with your doctors, other healthcare providers and your family will benefit the treatment.

What can the doctor do?

As a team

The cancer itself is treated in the hospital by a multidisciplinary oncology team made up of oncologists, surgeons, radiotherapists (for radiotherapy) and a specialized nursing team. If necessary, a psychological assistance is also planned. Pain treatment is therefore already starting in the hospital.

If the pain persists after discharge from the hospital, the general practitioner will supervise the management in consultation with the team and with your family. There are also palliative care teams composed of doctors and specialized nursing staff who help the patient and his family at home by offering support and care.

Principles

The principles of pain relief are:

  • Sufficient pain relief; a drug is considered effective if it reduces pain by at least 2 points on the pain scale, or if the pain decreases by at least 30%. The objective is to bring the perception of pain below the score of 5.
  • Workable treatment; someone who is vomiting or unable to swallow will not be able to take tablets.
  • A stable and constant dose of a delayed-action product for continuous pain;
  • Fast-acting drugs to treat pain peaks (intercurrent pain);
  • Regular monitoring and evaluation of treatment.

Side effects

Common side effects of morphine derivatives are nausea, the constipation and drowsiness. They rarely lead to psychic dependence. However, they should not be stopped suddenly because withdrawal symptoms are possible. In serious illnesses such as cancer, however, pain control is much more important than possible addiction.

Regular

There are a number of questions that can help when monitoring pain treatment:

  • Are you taking your medications correctly?
    • If not why ?
  • Are you suffering from side effects?
  • Are you afraid of becoming addicted to drugs?
  • Is the pain sufficiently relieved with the prescribed dose?
  • Did the pain score decrease?

Trial treatment

Sometimes a trial treatment with painkillers is needed to determine the nature of the pain. Sometimes we realize that pain is neuropathic because it does not respond sufficiently to conventional pain treatment.

For neuropathic pain, antidepressants, such as amitriptyline, and / or antiepileptics, such as carbamazepine and gabapentin, are given. Methadone can also be considered in this case. Neuropathic pain is often caused by anti-cancer drugs (chemotherapy) which cause inflammation of the nerves (polyneuritis). This type of pain is often very resistant to treatment.

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Source

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