Cancer is one disease where the treatment has the potential to do as much if not more harm than the disease. This is because the treatments with the laudable aim to destroy the cancer cells also destroy normal cells. The rapidly growing cells like those in the bone marrow, hair follicles are especially vulnerable as seen by the hair loss and low blood counts after chemotherapy. More subtle is the depletion of the nutrients by the rapid cell production to replace those destroyed by chemotherapy. Together these lead to the sudden development of swelling in the legs from loss of proteins, diarrhea, mouth ulcers and other deficiency symptoms that develop almost overnight.
Radiotherapy on the other hand produces its side effect rather slowly manifesting as radiation induced proctitis or cystitis (inflammation of rectum or of urinary bladder) or even a hole in a vital tube like the ureter , or fibrosis of lungs etc. A less understood /known complication is that of heat induced contractures of muscles. After all muscles are protein and this gets cooked solid during the radiation but manifests later as a contracture later. The se can be very painful because the muscles are usually fixed at their two ends to unyielding bone and as they shorten they pull constantly on the ends leading to pain and a burning sensation. Because muscles are essential to movement this can lead to untold miseries. Contractures of neck muscles can prevent a patient from lying down flat. They spend most nights sitting . same state prevails after muscles become rigid in the back after radiation for abdominal or pelvic cancer
Patients with cancer pains may have tremendous suffering because of the pain and because of the illness. What can be more devastating than cancer is the ignorance and the lack of understanding of the disease process on the part of the patients and their families. There is a lot of suffering associated with the illness which is borne many a time by the patient and the loved ones together. Many times, cancer pain can just be an offshoot of the aggressive treatment with chemo and radiotherapy rather than a disease process itself.
Cancer pain can be managed quite well, with medications ( analgesics and neuromodulatory drugs) simple treatment strategies like IMS, Physiotherapy, and lifestyle modifications. The WHO has formulated an analgesic ladder starting from simple painkillers through the medium levels to the most powerful ones in addition to the neuromodulatory drugs. Followed properly it affords a good quality of comfort to the patients. However there are certain categories of patients where this alone may not suffice. So the ladder has to be jumped inn these patients by performing interventions earlier rather than later. IMS does not form a part of the ladder but we find it an extremely efficacious part of treatment at Ashirvad achieving significant pain relief, reducing the dosage of medications allowing the patient to be alert and coherent in their interactions with the family. Physiotherapy adds to the benefits of IMS.
For severe pains, a number of interventions and nerve injections may be used to provide relief to the patient. Since spinal cord is the final common pathway for all the pains in the body below the head , treatments that target it can produce excellent pain relief. Technological advances have made it possible to implant drug delivery devices that release low doses of painkillers directly into the spinal cord ( Intrathecal pumps ITP). or implanted pacemakers that can reduce the pain from an affected area by Neuromodulation ( Spinal cord stimulators- SCS, PNS, etc. ).
The drug doses that are achieve good pain relief with ITP are minuscule ( pain scores of 1-3 on a scale of 1-10 with 1 0 being no pain and 10 being unbearable pain ) . As a result the patient is comfortable but alert awake, coherent and able to work professionally. Thus it adds a quality to life that is unmatched by any other therapy for cancer . Where the pain is severe enough to warrant it, it is better implanted early so that the patient derives the maximum benefit from this costly treatment . Waiting till the pain becomes unbearable defeats the purpose of pain management.
Thus in the present day context , there is no cancer pain that cannot be treated well. Cancer patients can be made painfree while staying alert with these modern interventions .
We at Ashirvad believe that our responsibility to the cancer patient does not end with pain relief . In addition we also take care of enteral and parenteral routes of nutrition . Towards this end we also insert peripheral long lines so that patients who cannot take food orally or through the enteral tube can receive nutrition intravenously as long as they are alive. This way they can have sufficient strength to interact with their near and dear ones at this precious twilight zone of their lives. The family also can feel gratified with the knowledge that they took adequate care of their beloved person. We have a homecare service for Cancer patients called SANDHYA ASHIRVAD. The first priority is to make the patient pain free with a combination of Nerve blocks, oral medicines, IMS and physiotherapy. Once the patient is pain free the other needs are taken care of as they arise.