Managing Cancer Pain
Radiation therapy, radiofrequency ablation, and surgery may be used for pain relief rather than as treatment for primary cancer. Certain chemotherapy drugs may also be used to manage cancer -related pain.
Local or whole-body radiation therapy may increase the effectiveness of pain medication and other noninvasive therapies by directly affecting the cause of the pain (for example, by reducing tumor size). A single injection of a radioactive agent may relieve pain when cancer spreads extensively to the bones. Radiation therapy also helps reduce pain-related interference with walking and other functions in patients who have cancer that has spread to the bones. It is possible for pain to come back after radiation therapy, though more studies about this need to be done.
Radiofrequency ablation uses a needle electrode to heat tumors and destroy them. This minimally invasive procedure may provide significant pain relief in patients who have cancer that has spread to the bones.
Surgery may be used to remove part or all of a tumor to reduce pain directly, relieve symptoms of obstruction or compression, and improve outcome, even increasing long-term survival.
Less invasive methods should be used for relieving pain before trying invasive treatment. Some patients, however, may need invasive therapy.
A nerve block is the injection of either a local anesthetic or a drug that inactivates nerves to control otherwise uncontrollable pain. Nerve blocks can be used to determine the source of pain, to treat painful conditions that respond to nerve blocks, to predict how the pain will respond to long-term treatments, and to prevent pain following procedures.
Surgery can be performed to implant devices that deliver drugs or electrically stimulate the nerves. In rare cases, surgery may be done to destroy a nerve or nerves that are part of the pain pathway.
Management of Procedural Pain
Many diagnostic and treatment procedures are painful. Pain related to procedures may be treated before it occurs. Local anesthetics and short-acting opioids can be used to manage procedure-related pain, if enough time is allowed for the drug to work. Anti-anxiety drugs and sedatives may be used to reduce anxiety or to sedate the patient. Treatments such as imagery or relaxation are useful in managing procedure-related pain and anxiety.
Patients usually tolerate procedures better when they know what to expect. Having a relative or friend stay with the patient during the procedure may help reduce anxiety.
Patients and family members should receive written instructions for managing the pain at home. They should receive information regarding whom to contact for questions related to pain management.