As cancer is a complex progressive disease, treating cancer pain is sometimes a big challenge.
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Cancer pain can be caused by the tumor invading the surrounding nerves, or it can be a side effect of the radiation or chemotherapy used to treat the cancer. Today, thanks to advanced pain management techniques, many patients can be spared the debilitating pain and suffering.
Nerve blocks target pain
“In general, 80-85 percent of patients do respond to narcotic treatment to manage the pain caused by cancer,” says Nagy Mekhail, MD, PhD, Director of Cleveland Clinic’s evidence-based Pain Management Research.
For the other 15-20 percent of patients who either don’t respond to the analgesic medications or who have serious side effects from these narcotic medications such as nausea, vomiting, sedation or constipation, Dr. Mekhail uses a targeted approach: Interventional Pain Management Techniques. These techniques work to target the actual pain generators or the nerves that transmit the pain signals.
Here are some important definitions:
- Diagnostic blocks are intended to identify pain generators.
- Prognostic blocks predict the potential benefit of ablating the blocked nerves.
- Therapeutic blocks aim to offer long-term pain relief and improve patients’ functionality. Patients who obtain short-term but substantial relief with diagnostic/prognostic blocks can benefit from therapeutic blocks.
Doctors first use diagnostic nerve blocks followed by therapeutic nerve blocks (ablations). The nerve blocks identify pain generators by delivering a very small dose of the medicine directly to the nerve where the pain begins or is transmitted.
Implantable drug delivery
Some cancer patients need pain medications delivered directly into the spinal fluid within the spinal cord. In those cases, doctors implant Intraspinal drug delivery systems (ISDD).
“The beauty of ISDD systems is that the amount of medication is 1/300 of the equivalent oral dose. It’s phenomenal how small the dose can be when it is directly targeting the nerves causing the pain and that reduces the possible side effects,” Dr. Mekhail says.
The ISDD systems have been around since the early 1990s, but they have advanced greatly over the last decade. Today, patients can have an implanted pump, which allows the patients themselves to administer on demand doses of the medication according to the prescription of the treating physician.
“I always recommend that my patients give themselves a dose just before they are planning to go out or do certain activities to avoid the pain caused by such efforts,” Dr. Mekhail says.
Many times nerve blocks work, but the duration of relief is relatively short. In these cases, the best way to have long-lasting effects is through nerve ablation.
Vertebral tumors ablation
“The most recent technique to control pain is to use cooled radiofrequency to ablate metastatic tumors to the vertebral column, a technique first adopted by Cleveland Clinic,” says Dr. Mekhail.
Finally, Dr. Mekhail notes that collaboration is critical to managing cancer pain. Physicians from pain management, oncology and palliative medicine must work together to determine the best interventions for each patient. Pain control is essential. The goal is to improve patients’ quality of life, functionality and to help them feel comfortable.