Saturday, July 6, 2013

Pain in cancer metastasis

Pain is an imminent symptom with cancer metastasis. Pain is mostly managed with medicinal drugs. But it generally does more harm than good in the long run. It does not solve the underlaying problem, save bringing temporary relief to the patient. All pain killers are toxic and additive. Pain is generally unbearable depending on one's level of pain tolerance.
The only recourse is prevention of cancer metastasis.
I append Dr Stephanie Harman's explanation and descriptions as posted in the popular cancer website GRACE:

Cancer Pain 101

In reviewing posts from GRACE, it’s not surprising to see that pain is major issue for many patients with cancer. Pain is not unique to cancer, but for most patients with cancer, their pain is related to the cancer in some way. In cancer, the causes of pain not only include the disease itself, but also the treatments and procedures involved. There are particular types of pain and pain syndromes that are seen primarily in patients with cancer compared to other illnesses. Within oncology and pain management, cancer pain is so crucial for patient care that it has become essentially its own specialty in recent years. Dr. Janet Abrahm, an oncologist and cancer pain expert at the Dana Farber, has written one of the definitive texts on cancer pain management which is a major reference for this post.

Cancer-related pain can be categorized in several ways into what time course it follows. Patients who have acute cancer-related pain have pain that is expected to improve with cancer-directed therapy or, if it is a treatment-related complication, will resolve after treatment. Chronic cancer-related pain is not expected to resolve or its source cannot be eradicated. This chronic pain is very frustrating; similar to non-cancer patients with chronic pain, treatment focuses on therapies that can help patients function and improve their quality of life.

In considering both the tumor itself and the treatments, there are three major types of pain that are experienced. These types can occur individually or simultaneously.

1. Somatic, body-related: This type of pain involves bone, muscle, skin, and connective tissues. It is usually described as an ache in a particular location and can be constant. As in pain with arthritis, the pain is worsened by movement. An example would be a cancer metastasis to a hip bone.

2. Visceral, organ-related: This type of pain refers to pain involving the organs of the body (like the liver or the intestines) and their linings (“viscera” is a medical term for an organ). It is more difficult to pinpoint a particular location. The pain often is described as a cramping or “squeezing” sensation that is felt deeply—it may also feel like an ache. An example would be a stretched liver due to metastases.

3. Neuropathic, nerve-related: This type of pain involves the nerves of the body, including the spinal cord. This pain is described as burning, sharp and shooting, and electrical—“pins and needles,” or paresthesias can occur as well. Depending on how a nerve is injured, there can be associated numbness or weakness as well. While it may be related to a particular nerve, it can be difficult to pinpoint a specific location. An example of this would be neuropathic pain in the feet and hands from platinum chemotherapy.

A General Approach to Cancer-Related Pain

Having pain is a reflection of having the disease of cancer, not of the patient themselves. Patients often tell me that they don’t bring up pain because they do not want to complain or they perceive that they’re “expected” to handle the pain in order to be “strong.” Physicians 

have also contributed to these barriers as well, as there have been misconceptions in practice about the interpretation of pain and the use of pain medications. I will address misconceptions about pain management further in a later post.

Pain is experienced differently by each patient. For example, pain from the same bone marrow biopsy can be experienced differently by different patients. While it may be rated differently amongst patients, what is recognized is that if the pain is not treated, that rating will remain the same or worsen. Pain is measured based on what a patient reports–that is central to how physicians can assess and treat cancer-related pain. Physicians use assessment tools like numeric scales to measure pain for severity as well as other factors to guide the evaluation and treatment of pain, including the quality of the pain, exacerbating factors such as activity or position, relieving factors such as medications or resting, and timing of the pain. When pain is particularly difficult to control, a pain “diary” can be very helpful in determining patterns of pain—one example would be to track episodes of pain with the date/time, severity, duration, use of medications, and response to medications. I see pain as an area where physicians and patients have the opportunity to collaborate closely to tailor treatment regimens, so that physicians are asking about pain on a regular basis and patients are equipped to better control their pain.

Pain is a complex experience that involves and affects other dimensions beyond the physical, including emotional and psychological well-being, cognition, and spirituality. These are all intricately intertwined. Consider that both anxiety and depression are exacerbated by pain. Pain can affect cognitive functioning, even to the point of causing delirium. The non-physical aspects of pain constitute a vast area of therapy and study—I will review this in a later post.

This is the first in a series of posts on cancer-related pain—while they will by no means be exhaustive, I hope to address common and challenging topics for patients. 

Link to dr Harman's post in GRACE

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