Cancer Pains

Each cancer patient describes the pain they experience to varying degrees. Indeed, the extent of the pain experienced varies depending on the underlying cancer type and the body’s resistance.

Cancer Pain Has Three Main Causes;

Pain due to invasion of tumor causing cancer with 75% probability

Pain due to radiotherapy and chemotherapy treatments in cancer treatment with a rate of 20%

5% is pain of completely different origin from other causes, i.e. cancer.

Localizations of Cancer Pain

Involvement of Bones: Bone pain can occur if the cancer has metastasized to the bones. Bone pain complaints are present in 20-30% of lung cancers and 50-70% of breast and prostate cancers. If the cancer has metastasized to the bone, some patients may not experience pain at all. However, the pains seen are mostly severe pains that start at night and increase with exercise. The situation is more complicated if there has been referred pain. For example, low back pain may be felt in the leg. If there is a nerve pressure pain caused by a tumor, it will give a stinging symptom.

Vertebral Involvement: It varies proportionally according to the vertebral regions where the cancer metastasizes. For example, 65% of the cases feel pain in the back, 20% in the lower back and pelvis, and 10% in the neck region. When there is Vertebral Involvement, the type of pain is always aching and localizable. Sometimes the pain can be relieved by standing and increased by sitting or pressing.

Head Involvement: There is a 50% probability of intracranial metastases and tumors in cancer patients. About half of them have headache complaints. Along with cancer and metastasis, conditions such as visual disturbances, neuropsychiatric diseases and hemiparesis can also be seen.

Pain Management in Cancer

The World Health Organization says that about 80% of cancer pains can be controlled. In this way, the quality of life of patients will also increase.

Deep information should be obtained about the cause, type, location of the pain, and when the pain started and its severity. The patient’s expression is extremely important in this situation. If the patient says “I have pain”, effective treatment methods should be started. The patient should be checked regularly and frequently. If the given drugs are not sufficient, dose increase or drug change should be made. If the treatment is started primarily parenterally, then oral or transdermal methods should be preferred. Relatives of the patients should also be active during the treatment process and should explain to the patient that their pain will be relieved even if it is not completely gone. It is very important to evaluate the patient objectively by the numerical pain scales in the controls by the physician.

Pain Severity in Cancer

The basic mechanism in the treatment of cancer pain; Determining the severity of pain and then controlling it. We can achieve this by communicating with the patient in a coordinated manner. Although pain is described subjectively by the patient, treatment can be planned according to the severity of the pain by using various numerical, verbal and visual scales. While no pain is evaluated with 0 (zero), excruciating pain is defined as 10 (ten).

Pain Treatment in Cancer

Although the World Health Organization offers the step treatment method for cancer pain to the whole world, the pain cannot be controlled because it cannot be applied sufficiently. The main goals in pain treatment are as follows;

Providing optimal pain control

Applying the treatment that will cause the least side effects

Improving the general condition of the patient

Raising the standard of living

In general, the minimum level of invasive intervention and the most effective treatments are planned. In cases where it is insufficient, more invasive treatments are preferred.

Direct methods of treating cancer include:

Surgical

Chemotherapy

Radiotherapy

palliative therapy

endocrine therapy

Radioisotope therapy

Pharmacological treatment

Physiotheraphy

Aromatherapy vs.

Pharmacological Treatment in Cancer Pain

There is “analgesic ladder therapy” which is widely used in cancer pain and recommended by the World Health Organization.

The drug that is important in the step treatment;

on the clock

Oral

It is to apply in appropriate doses.

If a treatment is applied in this way, approximately 80% of the pain can be controlled and patient comfort can be provided.

The most important aim of step therapy is to increase its usability in cancer pain. In the first step, treatment with nonopioid and nonsteroidal anti-inflammatory drugs can be started. Then, a mild opioid such as codeine should be preferred in addition to the first line in the second line. If pain persists, strong opioids such as morphine should be used. The biggest mistake of those who apply treatment is that they always start the treatment from the first step, no matter what level of pain the patient experiences. But this is extremely wrong. Considering the pain scale of the patient, treatment should be started from the appropriate step.

Step Treatment

First line: nonopioid + adjuvant

Second digit:nonopioid+adjuvant+weak opioid

Third line: nonopioid+adjuvant+strong opioid

Factors Increasing the Chance of Success of Step Treatment

Systemic analgesics should be given by appropriate route, in the right dose and at regular intervals.

Oral should be the first choice unless oral medication is contraindicated.

Treatment should be started with nonopioid drugs, but if pain persists, adjuvant drugs should be combined.

The pain scale of the patient must be taken into consideration and the treatment step must be chosen accordingly.

Nonopioid drugs

Acetaminophen

Aspirin

Diflucinal

Ibuprofen

indomethacin

naproxen

Opioid Drugs

Morphine

hydromorphine

Fentanyl

tramadol

Levorphanol

Codeine

methadone

Side Effects of Opioids

Opioids, which are indispensable drugs in the treatment of cancer pain, have some side effects. These;

Nausea

Vomiting

diarrhea

Itching

neuropsychiatric disorders

Dizziness

urinary retention

confusion

Pupillary shrinkage

There are myoclonic withdrawals.

Interventional Analgesia Methods in Cancer Treatment

Analgesic and opioid drugs used in the step treatment determined by the World Health Organization may be ineffective in some cases. Since the pain threshold will increase as the disease progresses, interventional analgesia methods, especially spinal opioid applications and nerve blocks applications, can be tried.

Interventional treatment methods are used on patients who cannot benefit from step therapy, patients who cannot use drugs due to side effects, patients with high pain scores, and patients who do not want to be involved in any step treatment.

Contraindications are as follows:

bleeding disorders

Infection

Patient’s rejection

The patient’s inability to afford the treatment

Contraindications arising from the intervention.

Interventional Analgesic Techniques

nerve blocks

Radiofrequency thermocoagulation methods

Epidural, intrathecal, intraventricular opioid

Pituitary alcohol and glycerol therapy

spinal cord stimulation