MICHAEL AGYEMANG KUFFOUR

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

- International Association for the Study of Pain (IASP)

Not all cancer patients experience pain

INTRODUCTION

Acute pain: ranges from mild to severe.

Chronic pain: ranges from mild to severe

Breakthrough pain: is an intense rise in pain that occurs suddenly or is felt for a short time

Types of Pain

Nociceptive

pain signals from nerve endings

Neuropathic

Pain resulting from damage to nerve

Types of Pain

Moderate to severe pain experienced by 40% to 50%

of cancer patients.

Very severe pain experienced by 25% to 30% of cancer patients .

80% of terminal stage cancer experience moderate to severe pain

Do all cancer patients suffer pain ?

Infection

bradykinins, a nerve growth factor, cytokines, etc.

Tumor related

Nervous system, bone, visceral, mucosal

Treatment Related

surgery, radiation therapy, chemotherapy, interventional procedures

Causes of Pain in Cancer Patients

Detailed history

o Location ; single or multiple

o Onset and duration ; variation.

o Characterization of pain

o Aggravating and relieving factors

o Effect of medications

o Effect of pain on patient’s life.

Diagnosis

Radiation

o Relieves pain by killing cell to reduce tumor size

o promotes re-mineralisation of bone.

o predominantly used for primary tumours associated

with osteoblastic metastases

o usually delivered as external beam treatment or

systemic radioisotopes

Management of Pain

Chemotherapy

o Kill cells, reduce tumor size and reduce tumor

compression on nerves

o Not suitable in tumors which are not chemo sensitive

o It can induce pain in itself

Management of Pain

Hormone Therapy

o Used in mostly breast and prostate cancers

o useful for patients with widespread disease and

metastatic pain

o Anti estrogen and anti androgen drugs are used

respectively

Management of Pain

Biphosphonates

o Slows down the rate of growth of bone crystals and their

dissolution

o used in the management of cancer-induced bone

pain(CIBP).

o reduce morbidity from bone metastasis by reducing

skeletal events and preventing the need for radiotherapy.

Management of Pain

Surgery

o Usually required in severe and unbearable pain

o involve interruption to or modification of nerve

conduction, with the aim of diminishing pain

from a target area

o may be considered to be non-destructive or

destructive.

Management of Pain

Increase wellbeing and thus influence pain.

employed in addition to conventional treatments in

palliative and supportive cancer care.

A large proportion of cancer pain patients use CAM

Complementary Therapy for Cancer Pain

Acupuncture

This is the insertion of needles into the skin and underlying tissues for therapeutic or preventive purposes at specific sites, known as acupuncture points.

Aromatherapy

This is the controlled use of plant essences, applied either to the skin through massage, added to baths or inhaled with steaming water.

Complementary Therapy for Cancer Pain

Hypnotherapy

This is the induction of a trance-like state to facilitate relaxation and enhance suggestibility for treating conditions and introduce behavioural changes.

Massage

This is the manipulation of the bodies soft tissue using various manual techniques and the application of pressure and traction.

Complementary Therapy for Cancer Pain

Mucositis is the painful inflammation and ulceration

of the mucousmembranes, which usually occurs in the mouth but can affect other areas of the mucosa in the gastro-intestinal tract

common after radiotherapy for cancer of the head and neck and after certain types of chemotherapy, such as 5-fluorouracil

Mucositis

o meticulous oral hygiene,

o gel-based barrier protection,

o the reduction of known painful precipitants (e.g.

alcohol)

o local anesthetic mouth washes and other oral

lubricants

Non-pharmacological treatment strategies include

Neurotoxicity is a dose-limiting side-effect of many

chemotherapies and biological therapies Peripheral neuropathy is the most prevalent form of neurotoxicity.

Risk factors for the development of CIPN

Longer duration of therapy.

High cumulative dose.

Type of chemotherapeutic agent (e.g vincristine, cisplatin, paclitaxel).

Pre-existing neuropathy (including CIPN).

Chemotherapy-induced Peripheral

Neuropathy (CIPN)

o The modification of chemotherapy dosage

schedules.

o Specific preventative treatments such as

amifostine, glutathione, N acetylcarnitine, N acetyl

cysteine and glutamine/glutamate

o Vitamin E can reduce cisplatin and paclitaxel-

induced neuropathy

Prevention and treatment

WHO LADDER

Some painful conditions that are seen in cancer

patients can be successfully managed by the use of

non-analgesic drugs.

Bisphosphonates and Calcitonin are used in treating bone pain and hypercalcemia in metastatic bone disease and multiple myeloma

Steroids alleviate pain due to CNS involvement, plexus or peripheral nerve compression and visceral

organ infiltration.

Non-analgesics drugs in pain management

Muscle relaxants like Baclofen, Diazepam or

Tizanidine can be used to relieve painful muscle spasms.

Anticholinergics are used to relieve smooth muscle spasms; Hyoscine is used to relieve intestinal colic; and Oxybutinin is used for painful bladder spasms.

Calcium-channel blockers like Nifedipine are used for the management of oesophageal spasms and tenesmus

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