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Pain Management for Cancer Patients

Cancer Pain Management

Cancer is a disease that causes various problems for the patients, it`s a disease that affects both the body and the mind. Patients who suffer from cancer usually face two types of problems, problems resulting from the disease itself and problems resulting from the treatments. While it `s usually hard to distinguish which problem belongs to which type, certain symptoms that appear in all types of cancer and with all treatments have been grouped together under the subtitle of the symptoms that are the result of the disease, while other symptoms that didn`t appear as much were grouped as the ones resulting from the treatment. To help a patient get properly diagnosed a nurse`s help is always needed, to allow the patients to understand more about what they feel and get then properly checked. One of the main symptoms that is commonly found in all types of cancer is pain.

Pain as a Symptom:

Cancer treatment depends mostly on a symptom management system which means that doctors work on making the patient feel better, but that doesn`t mean they are necessarily working on curing him. The symptom management system has lead the doctors to ignore a lot of important aspects when treating the disease (For Example; the ability to move independently) all for the sake of relief. Being in an incredible amount of pain, cancer patients usually seek powerful medications for pain relief. Medications that usually have a lot of side effects that would probably affect something else within their body other than the affected part. As the world health organization promotes it, cancer is a disease of “total pain” it pains a person both physically and emotionally, even with all the research and the powerful medications about 50% of the cancer patients receive insufficient pain relief and that still affects their daily life.

Cancer Pain Management:

As a very important symptom pain management is a priority within the treatment system, it usually depends on assessing the amount of pain a patient is feeling and that mostly depends on the patient himself. In order to reach an adequate diagnosis about the amount of pain a patient feels, a doctor asks the patient several questions;

1- How severe is the pain?

2- Describe the pain?

3- Where is the pain?

4- What makes your pain worse?

5- When was the last time you felt it and does it affect your daily life?

While the previous questions might give a doctor an idea about managing the pain of the patient it does not give the patient`s family an idea about how to understand when the patient is in pain. Different people express pain differently, some feel sad, some feel frustrated and others angry ,all those feelings attack a person’s mind and prevent him from expressing himself in the right way. In addition, Doctors tend to use analgesic drugs to manage cancer pain, the dosage and the effects of which differs based upon the amount pain.

Using Analgesic Drugs:

The effects of analgesic drugs differs from one patient to another and according to the dosage, however, it`s a truth that is well-know that most if not all analgesic drugs have a very bad side effects, the most noticeable are vomiting, nausea and constipation. While some experience only nausea and very little vomiting, some patients require a permanent anti-emetic medication along with their pain medication to prevent the vomiting and prevent any obstacles in the daily life of the patient. Cathartic should always be prescribed with the pain medication (Morphine) and There are three levels for the analgesic drugs. The first level is for patients with mild pain and drugs used in that one are usually non-narcotics, the second level is for patients with moderate pain and the prescribed medicine for such pain usually contain only a small amount of opioids, finally severe pain patients and they all usually take strong opioids medicine. Assessing the pain is essential in order to understand the mechanisms of the pain and, because If measured wrongly, it can increase rapidly on a patient to the point of fainting or losing consciousness.

Understanding Pain Mechanism:

The nervous system within a human being is connected to all the sensations their bodies feel and all the signals their brains send about pain, heat and so on. Out of all the nerves within the body only a couple of nerves are especially used for pain transmission; first, Large, heavy, myelinated A-beta fibers and they are the nerves responsible for the feeling of tenderness and heat on your skin, when injured the A-fiber gives the patient a big amount of pain. Second is the thin, small C fiber nerves , when injured they give the patient a numb and dull feeling. One of the most well-known pain management theories is the gate control series which states that the signals that are sent through your nervous system get controlled by a substantia gelatinosa and that large fibers tend to stop signals from the nerves while small fibers tend to allow the signals. Finally, As nerves understand pain the source of the pain differs from muscles to nerves to bones.

Bone Pain:

Determining that a bone has a tumor is usually done through pain assessment also. As the approximate percentage of getting a tumor growth within the bones is really high, bone metastases can involve any bone within the body. Once inside the body, the tumor can push on a nerve that would cause a great deal of pain for the user. For tumor growth within the bones Sometimes, no growth is seen when the cancer is first found. Instead, it is found later, after treatment, and When a cancer has come back after treatment, it’s called recurrence. Recurrence can appear anywhere in the patient’s body whether near the original treatment or away from it.

Characteristic of Bone Pain:

Many people with cancer will develop bone metastases at some point in their disease. Bones are often seen with a tumor in cases such as breast and prostate cancers. The spine is the most common site of bone cancer or bone tumor same with the hip and the skull. Once a tumor spreads inside the body and reaches the bone it might be impossible to treat anymore but it can still receive treatments for shrinking, radiation and other stuff. Other treatments can help inhibit or cope with cancer symptoms.

Management of Bone Pain:

Some bone metastases don`t cause a lot of pain, however, if they start growing near a nerve they do cause a large amount of pain. Bone metastases are only partly responsive to opioids, a combination of opioids and NSAID is needed to manage the pain. In cases where the tumor has started spreading radiotherapy is used to prevent the growth or shrink the tumor, with a success rate of over 80% radiotherapy is a method that can actually cause constant pain relief for the patients, however like all the other methods it has a lot of side effects that include constant vomiting and coughing fits. Another method used to manage bone metastases is the hemi-body irradiation which is used on patients with a more advanced sickness. However, it`s side effects are mostly distressing for the patients, especially hair loss as some patients see it as a mark that shows the world that they are sick especially since it is a side effect that is hard to erase. Still, hemi-body irradiation will most probably remain a good pain relief method for patients in the last stages of the sickness and those with which the other types of treatments didn`t work.

Neuropathic Pain:

It is muscle spasms that may arise from the disturbance of a function within the body and from damage or a change in the nervous system. Neuropathic pain is very exciting to manage because of the Ambiguity of its symptoms and underlying rules. There is often uncertainty regarding the nature and exact location of a health condition associated with neuropathic pain. Examples of common conditions that have peripheral neuropathic pain as a symptom are painful and neuropathic cancer pain. Neuropathic cancer pain may include different types of pain sensations sometimes dull sometime a prickling feeling and sometimes a sensation of extreme pain .

Main Cause of Neuropathic Pain:

Neuropathic pain can be caused by a lot of stuff which is why it`s hard to identify the specific reason as to why it started for a patient, Neuropathic cancer pain can be caused by a tumor pressing on a nerve, or by a nervous system injury like spinal cord compression and sometimes even as a result of the medications (intrathecal and epidural injections )applied by the doctors to the patients during cancer treatment. Even Radiotherapy causes neuropathic pain which may lead to plexo pathy, and neuropathy. Radiation and myelopathy. Another final cause for neuropathic pain would be applying a large dose of parenteral dexamethasone during treatment.

Management of Neuropathic Pain:

For the first line, neuropathic pain seem to respond quickly to Anti- depressant medication such as (amitriptyline) for which the pain responds in a way that is even quicker than depression itself. As a result, lower doses are used in treatment. however, while lower doses are used for amitriptyline some other anti-depressant might need higher dose and doctors would pay more attention because some of them have some bad side effects. Recent evidence also assets to using Gabapentin in reducing seizure frequency and reducing the amount of neuropathic pain.

Moving to the second line, Baclofen with a dose of about 20-120 mg appears to be a useful medication for the treatment of neuropathic pain, while local anesthetics such as Tocainide may be useful in continuous treatment in case anti-depressants didn`t work with a patient.


Finally, Although cancer is a very dangerous and practically torturous disease that involves a lot of pain , identifying the pain and understanding how it works and it`s types is very important for the sake of future treatment. Supporting the patient and helping them identify their symptoms will also help them reach their sought relief. Also, Applying the perfect pain killer for the perfect patient is what doctors and nurses do for the patients. Identifying the type of cancer and what stage a person is in helps identify the type of medication that should be applied and the methods that should be used whether radio therapy or hemi-body irradiation. Understanding that bone tumors are the mostly spread type is also very important as it determines the amount of pain killers used along with NSAID and helps patients reduce their pain. All in all, Patients with cancer face a large amount of pain that usually stands in front of their everyday life and as one of the main symptoms a solution for it was needed, however, a lot of doctors agrees that this solution cannot just be pain-killers there has to be a complete solution for the disease, something that would cure the patients completely.

Pain Management for Cancer Patients

Ali Badr
By : Ali Badr
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