Cancer Pain Management

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How much pain do cancer patients experience?

Thirty to 50% of people with cancer experience pain while undergoing treatment, and 70% to 90% of patients with advanced cancer experience constant pain.

What are the causes of cancer pain?

An estimated 70% of cancer pain is due to tumors that are embedded in the soft tissues, internal organs (liver, lungs, uterus, etc.), nerves, or bones; and to structural changes in the body such as muscle spasms.

Another 25% of cancer pain is due to therapy, including chemotherapy, radiotherapy, immunotherapy, and/or surgery.

Can we treat cancer pain?

Cancer pain can be treated effectively in 85% to 95% of patients with an integrated program of systemic, pharmacologic, and anti-cancer therapy.

How is it done?

The World Health Organization (WHO) recommends the following treatment guidelines for cancer pain:

a.      By mouth

Ideally, pain relievers should be taken orally. However, alternative routes such as through the rectum, under the skin (transdermal), under the tongue (sublingual), and through an intravenous (IV) drip may better serve patients with difficulty in swallowing, uncontrolled vomiting, or gastrointestinal obstruction.

b.     By the clock

Patients with continuous pain should take pain relievers at a fixed interval of time.

c.      By the ladder

The WHO analgesic ladder is based on the premise that cancer patients throughout the world gain adequate pain relief if health care professionals learn how to use effective and relatively inexpensive drugs, based on the severity of the patient’s pain.

d.     For the individual

The right dose is the dose that relieves the patient’s pain with least number of side effects.

e.      Attention to detail

Explain all the benefits and side effects of a patient’s pain reliever with regular follow-ups.

Why is cancer pain undertreated?

Cancer pain is always undertreated because there are barriers for effective cancer pain management like:

·        Lack of knowledge about the various mechanisms behind cancer pain syndromes

·        Lack of knowledge about the variety of medications used to treat the various mechanisms of pain

·        Failure to properly assess the patient in pain

·        Fear about addiction and the use of controlled substances

·        Fear of complications from or side effects of opioid analgesics

·        Lack of respect for or knowledge of non-pharmacologic therapies

·        Fear that use of opioids may hasten death

What is The Medical City (TMC) Pain Management Clinic’s ultimate goal in cancer pain management?

The ultimate goal is to achieve reasonable comfort and pain relief while minimizing the side effects of analgesics.

How exactly does the TMC Pain Management Clinic deal with your cancer pain?

First, it is important that the type and origin of your cancer pain be determined. The management of acute pain requires multimodal approaches, whereas the options for chronic pain treatment require the expertise of a multidisciplinary team for a favorable therapeutic outcome. Once the TMC Pain Management Clinic has recognized the type and origin of the pain, it will then work towards the relief of this pain so that you can have a fuller and better quality of life.

What is involved in the TMC Pain Management Clinic’s Multidimensional Program?

a.      Medication management either by use of oral, intravenous or patch analgesics, or by use of intravenous or epidural Patient Controlled Analgesia (PCA) devices.

b.      Injecting local anesthetic with or without steroids into a space around the spinal cord (epidural space), on a sore muscle (trigger point injection), etc.

How can The Medical City help you?

At The Medical City, we have a complete roster of competent pain experts who can address different types of pain. For further inquiries, or if you want to seek consult, please call:

PAIN MANAGEMENT CLINIC

3/F Nursing Tower 1, The Medical City

Tel. No. (+632) 988-1000 / (+632) 988-7000 ext. 6453

Email: painclinic@themedicalcity.com

DEPARTMENT OF ANESTHESIOLOGY

3/F Nursing Tower 1, The Medical City

Tel. No. (+632) 988-1000 / (+632) 988-7000 ext. 6258

Email: anesthesia@themedicalcity.com

CENTER FOR PATIENT PARTNERSHIP

17/F, Nursing Tower, The Medical City

Tel. No. (+632) 988-1000 / (+632) 988-7000 ext. 6444

Email: cpp@themedicalcity.com

Note: This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment.

REFERENCES:

·        Bonica’s Management of Pain, third edition by John D. Loeser

·        Pain Medicine and Management by Mark S. Wallace

·        The Massachusetts General Hospital Handbook of Pain Management second edition by Jane Ballantyne

·        TMC Pain Management Clinic

·        TMC Department of Anesthesiology