The 60-year-old was in excruciating pain as his lung cancer invaded his bones and brain. Escalating doses of opioids no longer kept pain at bay. The side effects were disabling.
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Enter a pain management specialist. He teamed up with the man’s oncologist and palliative care specialist.
A small pump was implanted near the man’s spinal cord. It sent out much smaller doses of anesthetic and opioid medication— where and when needed.
“The patient’s improvement was remarkable,” recalls Shrif Costandi, MD. “Pinpointing the source of pain and delivering drugs only to that site was far more effective.”
The intrathecal pump, along with two other techniques that specifically target the sources of cancer pain, bring hope to patients and families.
“These tools can greatly improve a cancer patient’s quality of life and help to wean them off opioids, especially if they are experiencing severe side effects,” he says.
Addressing a common problem
Over time, cancer can spread to bones, compress nerves or the spinal cord, or put pressure on organs, causing pain. In addition, treatment with chemotherapy or radiation therapy can sometimes lead to severe nerve (neuropathic) pain.
Opioid medications are not always effective. When they aren’t working, pain can become unbearable.
Long-term opioid use can also produce debilitating side effects, including severe constipation, drowsiness, fatigue and dizziness.
The resulting scenario is painful both for patients and those who love them. “In the cancer setting, these new options offer hope,” says Dr. Costandi.
1. The intrathecal pump
This implantable pump relieves pain and improves function by sending out variable concentrations of drug, when needed, to targeted sites. It helps two groups of patients:
- Those who fail to respond to oral opioids and could benefit from an alternate treatment
- Those who experience pain relief with opioids but are limited by severe side effects
The intrathecal pump also features a “patient therapy manager” option. This lets patients self-administer pain medication through the pump. When pain levels spike, they can increase the amount of drug they receive, within limits.
The pump is recommended for patients expected to live beyond three months.
2. The OsteoCool system
The OsteoCool™ system is also emerging as an alternative or additional method of pain relief. It is meant for patients with pain caused by the spread of cancer to the spine.
In an outpatient procedure, probes are inserted to deliver radiofrequency current to a precisely targeted spine region. They generate heat to dry out and destroy nerve cells. Water circulates through the probes to ensure that all targeted tissue is captured.
OsteoCool is meant for patients with one to three lesions limited to the spine who can’t have radiotherapy and whose spinal cords are not compressed.
“We’ve seen great outcomes with OsteoCool,” says Dr. Costandi. “It improves the quality of patients’ lives with minimal recovery time, while lessening overall opioid use and associated fatigue.”
3. Dorsal root ganglion stimulation
Dorsal root ganglion stimulation is a newer form of spinal cord neuromodulation that’s gaining traction as a tool for relieving cancer pain.
The dorsal root ganglion (DRG), which sits beneath each spinal nerve root, is the gateway for pain signals passing from the lower limbs to the brain. It is mainly indicated for neuropathic pain.
“Neuropathic pain can develop in the cancer patient population as a result of chemotherapy or radiation, or after a surgery such as thoracotomy,” says Dr. Costandi.
In traditional spinal cord stimulation, electrodes are placed along the dorsal column of the spinal cord and then stimulated to relieve pain.
In DRG stimulation, electrodes are placed over targeted dorsal ganglion roots and then stimulated. This shuts down pain signals to specific areas.
“DRG stimulation is particularly effective for patients with chronic, untreatable neuropathic pain,” says Dr. Costandi.
A measure of control
Cancer may not have a happy ending. But new pain relief options can bring comfort to patients and peace of mind to loved ones.
For example, when the man described at the start of our story began to develop breakthrough pain, he chose the pain therapy manager option.
Instead of adding oral opioids to his regimen and struggling with their side effects, he simply increased the dose his pump delivered.
“Six months after we implanted the pump, he reported minimal cancer pain and said his quality of life had greatly improved,” says Dr. Costandi.