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Cancer pain is often treated with oral medication and pain-relieving techniques such as relaxation and exercise. Sometimes, these options cause side effects or don't relieve the pain. If that's true for you, your doctor may prescribe interventional pain therapy such as a drug pump.
The choice for your treatment depends on your specific needs: the type and severity of pain, as well as how you respond to pain treatment. Not all treatments may be applicable to your type of pain. Treatments include:
Techniques such as relaxation, biofeedback, imagery, hypnosis, acupuncture, exercise, and counseling help many people use less pain medication. Your doctor can help you contact health professionals who may teach you these techniques.
Medication is often the first therapy that doctors use to manage chronic pain. Each patient will have a unique response to any medication, so your doctor may need to try a variety of drugs and dosages to find the most effective combination. Your treatment will depend on the type and severity of your pain, along with how well your pain responds to that treatment. Nonopioid oral medications include mild pain relievers such as acetaminophen and non-steroidal anti-inflammatory drugs like ibuprofen.
If nonopioid medications are not effective in controlling your pain, the next step is opioids, such as morphine or an analgesic patch. Opioids are similar to natural substances (endorphins) produced by the body to control pain.
External drug pumps deliver opioid medication through a tube inserted into a vein (intravenous) or into the epidural space of the spine. External systems often can effectively relieve pain.
If your oral medication no longer provides cancer pain relief or causes uncomfortable side effects, your doctor may consider a drug pump.
Typically, drug pumps are surgically placed in your abdomen. They send pain medication through a thin, flexible catheter (plastic tube) to the area around your spinal cord (called "the intrathecal space"). Because pain medication goes directly to the area around the spinal cord, the drug pump can offer significant pain relief with a small fraction of the medication used in other treatments. 1-3
Neurolytic blocks are injections directly into certain nerves that destroy them or stop the nerves from sending pain messages.
With neuroablation, doctors destroy (usually with heat) the nerves that serve as pathways to the brain. Neuroablation is often a last resort when other treatments have failed.
Onofrio BM, Yaksh TL. Long-Term Pain Relief Produced by Intrathecal Infusion in 53 Patients. J Neurosurg 1990; 72: 200-209.
Lamer TJ. Treatment of Cancer-Related Pain: When Orally Administered Medications Fail. Mayo Clin Proc 1994; 69:473-480.
Portenoy RK. Management of Common Opioid Side Effects During Long-Term Therapy of Cancer Pain. Ann Acad Med 1994; 23:160-170.
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