With a cancer pain diagnosis, techniques such as relaxation, biofeedback, imagery, hypnosis, acupuncture, exercise and counselling help many people use less pain medication. Your doctor can help you contact healthcare professionals who may teach you useful techniques or cancer pain management strategies.
NON-OPIOID ORAL MEDICATIONS (PILLS)
If you have a cancer pain diagnosis, oral medication is often the first therapy that doctors use to manage it. 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.
Non-opioid oral medications include mild pain relievers such as acetaminophen and non-steroidal anti-inflammatory drugs like ibuprofen.
If non-opioid medications are not effective in managing your cancer pain, the next step could be to use opioids such as oral morphine or an analgesic patch. Opioids are similar to natural substances called endorphins, which are produced by the body to control pain.
EXTERNAL DRUG DELIVERY
External drug pumps can deliver opioid medication through a tube inserted into a vein or into the epidural or intrathecal space of the spine. External drug delivery systems can often effectively relieve cancer pain2,3,7.
IMPLANTABLE DRUG DELIVERY SYSTEM
If your medication no longer provides cancer pain relief or causes uncomfortable side effects, your doctor may consider an approach using a drug pump implanted in the body to deliver medication.1
This type of system is made up of two components: a pump and a catheter. The pump is surgically placed in the abdomen, sending pain medication through a thin, flexible catheter (silicone tube) to the area around your spinal cord called the intrathecal space. Therefore, this system is called an intrathecal drug delivery (IDD) system.
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.4,5
Neurolytic blocks are injections directly into certain nerves that destroy them or stop the nerves from sending pain messages.
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.
With neuroablation, doctors destroy (usually with heat) the nerves that serve as pathways for the pain signal.
Candido KD, Kusper TM, Knezevic NN6. New Cancer Pain Treatment Options. Curr Pain Headache Rep. 2017 Feb;21(2):12
Mercandante S. Intravenous morphine for management of cancer pain. Lancet Oncol. 2010 May;11(5):484-9.
Burton AW, Rajagopal A, H, Shah HN et al. Epidural and intrathecal analgesia is effective in treating refractory cancer pain. Pain Med. 2004 Sep;5(3):239-47.
Bhatia G, Lau ME, Koury KM, Gulur P. Intrathecal Drug Delivery (ITDD) systems for cancer pain. F1000Research. 2014;2:96. doi: 10.12688/f1000research.2-96.v4
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.
World Health Organization. (1996). Cancer pain relief : with a guide to opioid availability, 2nd ed. World Health Organization. https://apps.who.int/iris/handle/10665/37896. Accessed on April 2020.
Zheng S, He L, Yang X, Li X, Yang Z. Evaluation of intrathecal drug delivery system for intractable pain in advanced malignancies: A prospective cohort study. Medicine 2017;96(11): e6354-e54.