Easing Pain Following Cancer Diagnosis

Monday, July 14, 2014 - 10:56am
Anesthesiologist, RPCI

Pain is one of the unfortunate realities of battling cancer. Whether it comes with the disease, or as a result of treatment, pain can be a major obstacle patients face while fighting cancer. The Roswell Park Pain Management Service seeks to help our patients manage their symptoms as best we can, with the ultimate goal of improving function and living full, complete lives.

Cancer-related pain is often more intense and difficult to treat than standard pain. It’s typically measured by using the standard intensity score, which asks patients to rate their pain on a scale from 0 to 10. Additionally, we correlate the patient’s history with any relevant findings such as radiological imaging results, tumor location, and any treatments the patient has received. Unfortunately, we don’t have a single imaging modality that will tell us exactly where someone’s pain is coming from, so we put the pieces of the puzzle together, both from what patients tell us and what we can find on other imaging and lab studies.

Medications are the starting point for most patients with significant cancer-related pain. Most patients who see us are familiar with opioids as primary pain medication. Opioids are beneficial for most types of cancer-related pain. Other classes of medications, such as antidepressants and anticonvulsants, can help with nerve pain — a common problem for cancer patients. Typically, the initial approach to treating cancer pain includes a combination of opioids and these other medications, which we call adjuvant medications.

Patients who do not receive adequate pain relief despite increases in opioids and adjuvant medications do have other options at Roswell Park. Ketamine can be used as a continuous infusion to block pain, as can surgical approaches, including pumps implanted in the body, delivering pain medication right to the spinal cord or wherever the pain is being processed.

Pain intensity does not always relate to pain suffering — rather the combination of emotional distress and limited daily functioning paint a more complete picture of pain suffering. With that in mind, we do our best to make life manageable for our patients and work to improve function and emotional well-being.

Cancer-related pain is difficult to eradicate altogether, but some patients do have complete resolution and are able to come off all pain medication. Typically, though, patients with cancer-related pain have some sort of persistent pain, and we see them as long as they need our services.