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Jakarta Post

Health sense : Treating cancer pain and improving your quality of life

Dr. Wilson Tay
Singapore   ●   Wed, January 28, 2015

Cancer pain is often chronic and usually related to nerve changes or damage. It can be persistent and difficult to treat.

However, it is important to note that not all individuals with cancer suffer from pain, because cancer cells do not have nerves of their own to transmit pain signals.

Where there is pain, it is likely due to three reasons.

First, the cancer might be pressing on nerves, bones or other organs. Second, certain chemotherapy drugs used to treat cancer might cause cause mouth sores (mucositis), peripheral neuropathy (numb and sometimes painful sensations in the feet, legs, fingers, hands and arms), muscle aches, joint pains and abdominal cramps. Other forms of treatment, such as radiotherapy, can also cause skin redness and irritation.

Third, sometimes there is pain that may have nothing to do with the cancer itself. A person may experience general aches and pains that everyone gets from time to time.

Pain can greatly affect a person'€™s quality of life. It can make it hard to perform daily activities, such as bathing, sleeping, eating and going out. It may also be hard for relatives and close friends to understand the pain, which can add stress and emotional distress to the individual.

If not controlled, a person can develop chronic pain.

It is necessary to take painkillers prescribed by your doctor, as these methods have been proven to successfully control pain in about 85 of every 100 people. Individuals who try to endure the pain and avoid painkillers can make the pain harder to control in the future.

However, different types of pain require different treatment. Therefore, it is essential to note the location, character, intensity and aggravating factors of the pain before you discuss things with a doctor.�

Nerve pain is caused by pressure on nerves or the spinal cord, or by damage to nerves. It is also called neuropathic pain.

The pain is often described by people as a burning, piercing, shooting, tingling or the feeling of insects crawling under their skin.

Some people develop nerve pain after cancer surgery. Nerves cut during procedures take a long time to heal, because they grow very slowly. Some people may have pain around their scars for many years. Nerve pain can also occur after chemotherapy and radiotherapy.

For nerve pain in certain areas, your doctor might suggest a nerve block, which is a way to '€œkill'€ the nerve (neurolysis) to stop it from causing pain. An example is coeliac plexus neurolysis, commonly used to treat ongoing pain in people suffering from pancreatic cancer.

Sometimes a small pump is used to deliver painkillers directly into the fluid surrounding the spinal cord. The pump is placed in your back area just below the waist, called an implanted intrathecal pump.

The pump can be refilled with painkillers every month or longer, depending on your usage or pain requirement.

This type of treatment is usually used where other methods are ineffective. You can stay at home with the pump.

Cancer can also spread into the bone, causing pain. The cancer may affect one specific area of bone or several areas. This type of pain is usually described as aching, dull or throbbing. The pain can also result in muscles spasms, increasing the pain'€™s intensity, especially if the spine is involved.

Cancer in the bones can make the bones weak and increase the risk of pathological fractures. When this happens in the spine, cement vertebroplasty is a safe and effective method to ease the pain and to strengthen and support the spine.

Sometimes pain from an organ invaded by cancer may be felt in a different part of the body. This is called referred pain. For example, a liver swollen from cancer may cause pain in the right shoulder, even though the liver is under the ribs on the right side of the body. This is because the liver presses on nerves that end in the shoulder.

How much pain one might have depends on the type, location and stage of cancer and whether the cancer or its treatment has damaged any nerves

Other factors, such as fear, anxiety, depression and a lack of sleep, can also affect how pain is felt.

If you have pain, it is very important to let your medical team know straight away. It is possible to relieve all pain to some extent with the right treatment. With good pain control, most people should be able to be free of pain when they are lying down or sitting.

Finally, remember some basic facts about cancer pain.

First, the World Health Organization reports that in 85 to 97 percent of all cancer cases, pain can be controlled.

Second, cancer patients taking opioids and other medications do not become '€œdrug addicts'€, despite the fears that many people have.

Third, taking medication for pain when it is needed does not mean that there will be '€œnothing left'€ to treat the pain in the future when the pain gets worse. There is always more that can be done to treat your pain.

Fourth, expert help in managing your cancer pain is available.

The writer, a consultant pain specialist, is a visiting consultant at the Pain Management Center and the Department of Anaesthesiology at Singapore General Hospital. For more information, visit