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Pain Relief for Cancer-Related Pain
Pain is a common symptom of cancer pain, with a third of patients experiencing pain at the time of diagnosis, and 60% of patients with advanced cancer living with untreated pain. The treatment of cancer pain varies from patient to patient, but one thing can be justifiably said: with today’s modern pain relief methods, the pain associated with cancer can be alleviated, treated, and often eliminated, ensuring a better quality of life for the patient.
What kind of pain does cancer cause?
The symptoms of cancer pain vary from person to person. The severity of pain may depend on the type of cancer, the stage or extent of the disease, and the location of metastases. The pain can be mild or severe, intermittent or constant, and it may manifest as abdominal, chest, or pelvic pain, bone pain, nerve pain, weakness of extremities, or a variety of other symptoms. Bone metastases not only cause significant pain but can also lead to the bones collapsing, as they generally weaken from cancerous transformation. Fractures of the vertebrae, sacrum, pelvis, upper arm, and femur are common. Fractures further increase pain, often rendering the patient bedridden and difficult to care for.
However, knowing this, therapy appropriate to the extent and stage of the disease can be developed, always in such a way that pain relief does not hinder oncological treatment. It is best to contact a pain relief specialist as soon as the diagnosis is made, so that pain management can proceed in conjunction with the disease.
What solutions are available for treating cancer?
Oncologists often start patients on a combination of pain medications, but in severe cases, this may not be sufficient to manage pain, or the side effects (drowsiness, nausea, constipation) may limit their use. In such cases, a pain physician can help optimize medication management and treat local pain with various temporary or permanent minimally invasive interventions, such as:
Nerve Block
During a nerve block, a thin needle is guided to the nerve to be treated, followed by the administration of an anesthetic and usually a steroid or sometime a long lasting neurolytic solution to calm the nerve. The procedure is guided by ultrasound and/or X-ray. This intervention can be both diagnostic and therapeutic.
Radiofrequency (RF) Treatment
Similar to a nerve block, a special needle is guided to the nerve to be treated, and then the nerve function is permanently eliminated with radiofrequency treatment, thus relieving the pain. Some nerves can and some cannot be treated with this method, this will be discussed with you and your treating physician.
Cryotherapy
Cryotherapy or cryoablation involves the targeted freezing of a nerve using a so-called percutaneous, or through-the-skin puncture method. No incision is made in the skin; just a special needle is guided to the nerve.
Vertebroplasty and Other Osteoplasties
In the case of bone metastases, the first therapy is usually medication, but often what’s called osteoplasty is needed. During this procedure, the cancerously transformed, painful, and fracture-prone bone is filled with medical cement. This not only prevents fracture but also has an immediate pain-relieving effect. An example is vertebroplasty, which is a method of treating vertebral metastases. However, the thigh bone (femur), pelvis, sacrum, and arm bone (humerus) can also be effectively treated with this bone-filling method.
Intrathecal Catheter and Pump
When an intrathecal catheter and drug delivery pump are implanted, a very thin (1mm), soft catheter is guided next to the spinal cord, exactly to the area where spinal anesthesia is performed for surgeries.
Intrathecal (IT) Alcohol Neurolysis
During IT alcohol neurolysis, in cases of severe unilateral upper limb and thoracic pain, sensory innervation can be turned off with alcohol administered in the spinal canal. This does not result in the loss of motor nerve function.
Chordotomy
In a chordotomy, a bundle in the spinal cord is treated with radiofrequency procedure, thereby eliminating the sensation of heat and pain on the opposite side of the body. It is recommended for unilateral, severe pain associated with tumors. This does not result in the loss of motor nerve function.
Cancer Pain Treatment with Sympathetic Block and Radiofrequency Treatment
There is a chain of nerves just in front of the vertebral bodies, that is responsible for transmitting pain and temperature information back and forth between the arms, legs, abdomen and pelvis and the spinal cord and brain. These can be selectively turned off with percutaneous procedures that are collectively called sympathetic nerve blocks. A permanent version is available of all of them, typically performed with radiofrequency ablation, but it is typically preceded by a diagnostic injection.
Splanchnic Block and Prolonged Neurolysis
The splanchnic block and prolonged neurolysis are recommended for the treatment of pain in pancreatic and other abdominal tumors. It typically significantly reduces pain for several years, and the patient can reduce the use of other medications.
Thoracic Block and Prolonged Neurolysis
During thoracic block and prolonged radiofrequency neurolysis, a nerve center at the height of the T2 and T3 vertebrae is turned off. This reduces pain in the upper limbs and increases circulation. It is recommended for lymphatic circulation disorders and other chronic pain as well.
Hypogastric Block and Prolonged Neurolysis
The hypogastric block and prolonged neurolysis are recommended for the treatment of pelvic cancer pain. The hypogastric nerve refers to a group of nerve bundles located in front of the L5 and S1 vertebrae. It plays an important role in the regulation of heat and pain. *Chemical neurolysis can inhibit its function and thus reduce pain if the diagnostic block was positive. It typically significantly reduces pain for several years, and the patient can reduce the use of other medications.
Ganglion Impar Block and Prolonged Neurolysis
The ganglion impar block and prolonged neurolysis are recommended for the treatment of cancer pain in the perineal, vaginal, and rectal areas. The ganglion impar refers to a group of nerve bundles located in front of the lower part of the sacrum. It plays an important role in the regulation of heat and pain. Radiofrequency and chemical neurolysis can inhibit its function and thus reduce pain if the diagnostic block was positive. It typically significantly reduces pain for several years, and the patient can reduce the use of other medications.
The array of solutions is indeed almost limitless, and always adapts to the patient, the condition of the disease, the current oncological treatment, the expected lifespan, and the patient’s personal preferences.
In addition to this, the psychological support of the patient is particularly important. Such a diagnosis is a huge mental and psychologic burden for both the patient and their relatives, which is not easy to bear or process alone.
* During chemical neurolysis, we reduce the function of nerves using alcohol or phenol. It is often applied for deactivating small nerves in cases of cancer-related pain. Generally, its effect lasts for 3 to 6 months.
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