Cancer and cancer treatments can sometimes cause moderate to severe pain. If you’re suffering from cancer pain, it’s good to know that managing your pain is possible.
what is cancer?
The term “cancer” refers to any one of a large number of diseases. People with cancer have abnormal cells in their bodies that divide uncontrollably and can destroy normal body tissue. Cancer can spread throughout the body and sometimes causes moderate to severe pain.
what causes cancer pain?
There are a number of biological reasons you may feel cancer pain. These include1:
- The direct effect of a cancerous growth on nearby tissues and body structures. Such a growth (sometimes referred to as a neoplasm or a tumour) may grow into or crowd out organs, nerves and other parts of the body
- The side effect of cancer treatments such as surgery, radiation or chemotherapy
- Pain due to disease progression
what are the different types of cancer pain?
Cancer pain usually falls into one of two categories1:
- Nociceptive pain: this is caused by damage to body tissue and is usually described as sharp, aching or throbbing. Nociceptive pain can be caused by cancer spreading to the bones, muscles or joints, or something that causes the blockage of an organ or blood vessels
- Neuropathic pain: this is caused by actual nerve damage and is often described as a burning or heavy sensation, or numbness. Neuropathic pain can be caused by a cancer tumour pressing on a nerve or a group of nerves
In general, patients faces multi-factorial pain, called mix pain linked to diverse causes of pain.
Not only cancer generate pain but side effect of cancer treatments such as surgery, radiation or chemotherapy can be the originator of pain.1
Chronic cancer pain continues long after the injury or treatment is over, and can range from mild to severe. Chronic cancer pain is also called persistent pain and can be experienced at all times.1,2
In addition to persistent pain, you may be experiencing breakthrough cancer pain, a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain.6
BREAKTHROUGH CANCER PAIN
- The onset is sudden and reaches a maximum intensity within 1 second to 30 minutes (median of about 3 minutes).
- Averages 4 to 6 episodes per day.
- The median duration of each episode is about 15 to 30 minutes.
- Episodes of breakthrough pain may or may not be associated with a precipitating factor and therefore may or may not be predictable. Precipitating factors can be identified in 55% to 80% of all episodes.
CHRONIC CANCER PAIN AND BREAKTHROUGH PAIN
HOW IS CANCER PAIN DIAGNOSED?
If you think you might be experiencing cancer pain, you should consult a medical professional who will carry out an evaluation and offer a diagnosis where possible. The description of the pain is very important to a doctor’s understanding of its intensity (usually with a pain-rating scale 0-10) and character (e.g., is it dull, sharp, achy, or shooting?)2.
Your doctor may diagnose you with chronic severe cancer pain if:
- Your pain doesn’t go away, even when medication is taken as directed
- Side effects are getting in the way of your daily activities or reducing your quality of life3,4
Understanding your pain
If you’re living with chronic pain due to cancer, you may think it’s a natural part of the disease and something to be endured.
You may have tried various pain medication, but can’t gain control of your pain.
You may have also decided that side effects from pain medications − like nausea, confusion and constipation − must be tolerated.
You don’t have to live this way; there is hope
By finding pain relief and reducing side effects, you may feel better. Intrathecal drug delivery aims to reduce uncontrolled cancer pain while minimising side effects, allowing you to experience each day with improved energy and quality of life.3,4,7
Grond S et al. Assessment of cancer pain: a prospective evaluation in 2266 cancer patients referred to a pain service. Pain. 1996;64(1):107–14.
Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, Ripamonti CI. on behalf of the ESMO Guidelines Committee Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of Oncology 2018;29(Supplement_4): iv166-iv91.
Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery (IDDS) system compared with comprehensive medical management (CMM) for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20(19):4040–9.
Smith TJ, Coyne PJ. Implantable drug delivery systems (IDDS) after failure of comprehensive medical management (CMM) can palliate symptoms in the most refractory cancer pain patients. J Palliat Med. 2005;8(4):736–42.
Mishra S, Bhatnagar S, Chaudhary P, Pratap Singh Rana S. Breakthrough Cancer Pain: Review of Prevalence, Characteristics and Management. Indian J Palliat Care. 2009 Jan-Jun; 15(1): 14–18.
Davies AN, Dickman A, Reid C, Stevens A-M, Zeppetella G. The management of cancer-related breakthrough pain: Recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. European Journal of Pain 2009;13(4): 331-38.
Stearns L, Abd-Elsayed A, Perruchoud C, et. al. Intrathecal drug delivery systems for cancer pain: an analysis of a prospective, multicenter product surveillance registry. Anesth Analg. 2020 Feb;130(2):289-297.