Palliative Services for Cancer Pain

Cancer pain is a mixture of nociceptive and neuropathic pains both of which are very much treatable.

Pain in cancer is caused due to several reasons.
1. It could be due to the pressure and infiltrating effects of cancer mass or Due to its spread to other organs.
2. Pain is also caused due to cancer treatment.
a. It may occur as persistent pain after surgery as post surgical neuromyopathic pain,
b. due to side effects of chemotherapy or immunotherapy or
c. radiotherapy and present as painful neuropathies and plexopathies.

Cancer pain is pain that is caused by cancer or cancer treatment. It can be acute, meaning it comes on suddenly and lasts for a short period of time, or it can be chronic, meaning it persists over a longer period of time. Cancer pain can be caused by the cancer itself, by the cancer treatment, or by other conditions that are related to cancer, such as nerve damage or bone fractures.
Cancer pain can vary in intensity and location, and it may be constant or intermittent. It can be mild, moderate, or severe, and it may be sharp or dull, aching or throbbing. Cancer pain can occur in any part of the body, depending on the location of the cancer.
Treatment for cancer pain will depend on the cause and severity of the pain. It may include medications, physical therapy, and in some cases, surgery.

The Concept Of Total Pain:

Dame Cicely Saunders coined the term ‘‘total pain’’ and suggested that pain can be understood as having physical, psychological, social, emotional, and spiritual components that affect a person’s pain experience. The ‘‘total pain’’ experience is individualized and is specific to each patient’s particular situation. It takes into consideration that suffering need not be confined to physical pain alone but might be relate to, and the result of, the person’s physical, psychological, social or cultural, spiritual and practical state. Thus to treat cancer pain effectively, it is important to approach it as a bio (physical), psycho (mind, emotion, spiritual), social(cultural and practical situations), condition and address it accordingly.

The more severe the pain, the heavier a toll it takes on the person’s well-being. Conversely, pain intensity can be increased or prolonged by the same emotions such as fear, depression, stress, or anxiety. However it is only rarely that pain originates from a purely psychological condition (Psychogenic pain) but most often has a physical origin either in tissue damage or nerve damage.

A cancer patient faces some specific issues like end of life situation where matters of financial, emotional and social importance have to be settled, and also make their farewells to take leave of their loved ones in a definitive manner.

Is cancer pain treatable?

The answer is a definite YES. Cancer pain is a mixture of nociceptive and neuropathic pains both of which are very much treatable. Up to 45% of cancer pains are neuropathic pains and when we look at neuropathy as neuromyopathic they become eminently treatable by combination of nerve block and USGDN and/or BOTOX. However the pain in a palliative care situation should be considered from the perspective of total pain.

The available treatments at our clinic are :

Medical management
Medications by the WHO ladder
IV lignocaine and ketamine infusions for neuropathic pains in cancer.

Interventions
Stellate ganglion block for head and neck cancers
Continuous brachial plexus block for upper extremity pains particularly post mastectomy pain syndromes (ref) and Pancoast tumour
Paravertebral block and catheters for thoracic pain
Celiac plexus block for abdominal pains
Superior hypogastric and Ganglion Impar blocks for pelvic pains.
Ultrasound guided dry needling and,Ultrasound guided Botox injections, for addressing the muscle pains which are the hallmark of all neuromyopathic pains.

Medical management from mild pain killers to potent opioid pain killers along with neuromodulator and other medications.
supportive therapies like physiotherapy and psychological counselling
Nerve blocks like
- - Celiac plexus block for abdominal pains
  - Hypogastric, ganglion impar and lumbar sympathetic block for pains of lower abdomen and lower limb
  - Continuous brachial plexus catheters for pains down the upper limb in breast cancer and some types of lung cancers
  - Advanced interventions like epidural port or intrathecal pump for severe pains.
  - RF ablation of specific nerves/ganglions involved in the cancer pain
  - RF cordotomy for selected patients.

Palliative Services for Cancer Pain

The available treatments at our clinic are :

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