Managing the Pain that is Caused by Cancer

Managing cancer pain is highly complex. It can be divided into pharmacological treatment, anti- cancer treatments, non-pharmacological methods and interventional techniques. 

Pharmacological treatment includes using drugs such as opioids (e.g. morphine), drugs to treat neuropathic pain (anti-epileptics, antidepressants etc), and steroids. 

Non-pharmacological methods include exercise therapy, psychosocial therapy, and traditional and complementary medicine (e.g. acupuncture). 

Anti-cancer treatment includes radiotherapy and chemotherapy. 

Meanwhile, there is a wide range of interventional techniques available for the relief of cancer pain. 

These methods should be considered when conventional therapy, as mentioned above, fails to provide adequate pain control. 

Examples of interventional techniques are nerve blocks, neurolysis, and insertion of an intrathecal morphine pump. 

A nerve block is done by injecting local anaesthetics – sometimes combined with steroids – to block sensation to an area of the body. 

For instance, if a patient has bone cancer of the arm, we would inject local anaesthetics around the nerve that supplies the arm in order to stop the pain sensation there. 

However, the application of local anaesthetics may not last long due to the drugs’ limited time effect, thus, this is usually done for diagnostic purposes. 

Neurolysis is a technique that is used to alleviate pain. 

It is done either by using chemical agents (e.g. alcohol or phenol) or thermal techniques (e.g. radiofrequency ablation) on the nervous system. 

Neurolysis is only used when the disease has progressed to a point where no other pain treatments are effective. 

And an intrathecal pump is a device that delivers small quantities of pain medication such as morphine, directly to the spinal fluid. 

When these drugs are used and delivered in smaller doses, it may minimise the side effects often experienced with larger oral doses of the same medications, and patients may also experience better pain relief. 

Patients who should be considered for these interventions include those with significant pain from locally- advanced disease, severe neuropathic pain, and severe pain on movement.