Cancer Pain Relief

Definition:

Cancer pain incorporates every discomfort generated by the tumor itself or by the necessary therapies.

Incidence:

About half of all tumor patients suffer from pain in the course of their disease, with increasing incidence up to two thirds in advanced tumor stages. Fifty percent of patients report on mild to moderate pain, but 30% on insufferable pain.

Possible Reasons:

About 60 to 80% of tumor pain is directly related to the underlying disease (eg. impressions of the vertebral bodies or infiltration of cancer into the nerves plexus), and about 10% indirectly related (i.e. tumor associated), with different frequency regarding to the tumor entity. However, in nearly 20% of the patients the reason of cancer pain is caused by the tumor treatment (eg. mucositis following chemotherapy) or diagnostic procedures (eg. biopsies), a fact, that strongly necessitates sufficient pain relief.

Symptoms:

Nociceptive pain (nociceptors are nerve endings that exist throughout the body) refers to the discomfort resulting from tissue damage by the tumor itself, and is distinguished as either somatic (sharp, stinging; well localized) or visceral pain (pain originating in the body´s internal organs or their surrounding tissues; not well localized). Neuropathic pain results from damage of nerve cells or nerves, affects the whole innervations area, and is poorly localized. Psychogenic pain (such as phantom limb pain) misses direct correlation with nerves or tissue and is therefore hardly to treat. Breakthrough pain is a transitory exacerbation of pain in otherwise acceptable analgesia, occurs immediate and last from seconds up to 30 minutes, thereby difficult to control.

Diagnostic Investigations:

Beneath radiologic examinations like x-ray, ultrasound, CT-scan, MRT-scan, and physical examination, the medical history is of essential importance, since the patient must be involved in the treatment by reporting his condition in sufficient detail, thus enabling the most effective therapy.

Tretament Options:

The elimination of the reason causing cancer pain is not always possible. Effective pain relief is therefore based on the WHO graduated scheme (published first in 1986), which - depending on the pain intensity - recommends the administration of different drugs and/or drug-combinations (step 1: non-opiod-analgetics, step 2: opiods for mild to moderate pain, and step 3: opiods for moderate to severe pain). In addition, adjuvants and co-analgetics are suggested in all steps. Using this 3-step approach, cancer pain mitigation is possible in more than 90% of patients. Side effects, especially during opiod treatment, usually occur in the beginning and can easily be attenuated by concomitant medication. Opiod addiction, patients mostly fare afraid of, is negligible and out of all proportion to pain relief at all. Surgical intervention on appropriate nerves or radiopharmaceutical procedures may provide further pain relief if drug adjustment is ineffective.