Pain interventions in cancer

One of the most important problems encountered in cancer patients is pain. Approximately half of these patients develop pain requiring treatment at any stage of the disease. Nearly two-thirds of end-stage cancer patients have severe pain. Pain in cancer develops for many reasons. The most common cause is the spread of the tumor to the nerves or its compression. However, chemotherapy, radiotherapy or surgical procedures may also cause pain.

 

The classical approach to cancer pain is the administration of pain medication. When these drugs are inadequate, the dose is increased or narcotic drugs are used. If narcotic drugs are not sufficient, some pain relief measures are applied. The most important of these interventions are nerve blocks. Especially celiac ganglion block applied for abdominal pain is very successful in relieving pain caused by tumors located in upper abdominal region such as pancreas and stomach cancer. Similarly, hypogastric ganglion block may be beneficial in tumor pain in the lower abdomen. One of the most important causes of pain in cancer is the spread of tumors to the bone and the destruction of the outer membrane of the bone called "periosteum". The classical approach in painful bone tumors is radiotherapy. However, the effect of radiotherapy starts late (after weeks), it is ineffective in 20-30% of the patients and in about half, the pain recurs in months but radiotherapy can not be applied to the same location. In such patients, percutaneous ablation of the periosteum is extremely beneficial. In pain management, percutaneous ablation is generally more effective and its effect lasts longer than radiotherapy.

 

In some cancers, the bones are severely weakened, and collapse  (compression fractures) occur as the vertebrae are unable to bear the weight of the body. In such patients, a special cement is injected into the vertebra through a needle in the early period of the collapse. With this procedure, called vertebroplasty or cementoplasty, the bone is hardened and prevented from collapsing and the pain is reduced as the cement destroys the nerve endings.

 

In order to cure pain in cancer, it is very important that oncology, interventional radiology, and algology (pain specialists) work in collaboration. In some patient groups, early intervention in pain has been reported to give better results in terms of pain, the quality of life and even survival of the patient or decrease of the side effects due to narcotic drugs.