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Control Your Cancer Pain

And Get Back to Doing the Things You Enjoy

by Dhanalakshmi Koyyalagunta, MD

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(Photo by Monkeybusinessimages /

Pain is a distressing but common side effect of cancer and its treatment. In fact, many of the estimated 14 million cancer survivors in the United States will experience cancer pain at some point.

For some, the cancer itself is the cause of the pain, for example, when it invades the bone, soft tissue, blood vessels, hollow organs, or nervous system. For others, cancer treatments can lead to painful chemotherapy-induced periph­eral neuropathy, radiation-induced tissue damage, and post-surgical pain. Co-morbidities, as well as a constellation of cancer-related psychological issues, can further exacerbate cancer pain.

Getting your pain under control is crucial, as unrelieved pain can have a significant negative impact on your quality of life. The goal of a pain man­agement program is to reduce pain with medication and procedural therapies, to restore function using rehabilitation techniques, and to help ease residual pain and distress using psychological interventions and alternative therapies.

Putting Together a Plan
Develop­ing a plan for treating pain begins with a thorough review of your medical history and a physical examination by your healthcare provider. During the initial assessment, your doctor will ask you about the severity and type of pain you’re experiencing and about your use of pain-relieving medications or other adjuvant therapies. He or she will also take into consideration your general med­ical condition and the cause of your pain. Setting goals and expectations for your pain-management plan early on is im­portant, as this will help outline the anticipated outcome of the therapies, as well as their limitations and possible side effects.

Getting your pain under control is crucial, as unrelieved pain can have a significant negative impact on your quality of life.

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Dr. Dhanalakshmi Koyyalagunta

Your doctor will pre­scribe pain-relieving medications based on the athophysiology of your pain, in other words the cause and type of your pain. Your doctor will also take into account any comorbidities you may have.

Opioids can be beneficial in treating cancer pain, but their side effects should be closely monitored. For mild to mod­erate pain, your doctor may prescribe weak opioids like tramadol, codeine, or hydrocodone. For moderate to severe pain, morphine, oxycodone, hydromor­phone, fentanyl, or methadone may be prescribed. Your doctor will work with you to determine the appropriate medi­cation and dosage needed to relieve your pain. Generally, the amount of medication that relieves your pain with the least problematic side effects is the appropriate dosage.

Various adjuvant pain relieving ther­apies can be used to help resolve any additional complications caused by your pain. These may include non-steroidal anti-inflammatories, acetaminophen, antidepressants, anticonvulsants, local anesthetics, Capsaicin or other topical creams, NMDA receptor antagonists, sympatholytic agents, calcium channel blockers, muscle relaxants, calcitonin, bisphosphonates, and steroids.

Procedural Therapies
The use of opioids and adjuvant medications alone may not be enough to control your pain completely. Procedural therapies can be employed at any point to help relieve your pain, especially if other pain-relief methods aren’t providing enough relief or if they’re causing problematic side effects.

Individual nerves or nerve bundles can be blocked with neurolytic agents , such as alcohol or phenol. For example, injections of neurolytic agents into the nerves in the abdominal and pelvic region can be performed to relieve abdominal and pelvic pain.

Medications can be delivered near the spinal canal using external or internal pumps. Small amounts of med­ications can be delivered into the spinal space to treat refractory cancer pain as well. Spinal cord stimulators are an option for relieving neuropathic pain.

Pain from spinal fractures can be treated with vertebroplasty and kypho­plasty . For these procedures, acrylic cement is injected into the fractured bone. Cordotomy and myelotomy are pro­cedures in which the pain pathways are interrupted using needle-guided thermo-coagulation.

When cancer pain begins to affect your qual­ity of life, it’s time to seek relief. For the most effective cancer pain management approach, work with your doc­tor to develop a multidisciplinary, multimodal plan based on your individual needs.

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Dr. Dhanalakshmi Koyyalagunta is a pro­fessor in the department of Anesthesiology and Pain Medicine at The University of Texas MD Anderson Cancer Center in Houston, TX.

This article was published in Coping® with Cancer magazine, September/October 2013.

Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.