As every one of us know that the number of cancer patients is increasing worldwide. Our country is no different, as the number of new cases is on rise. Most of the time unfortunately due to varied reasons; at the time of diagnosis it will be incurable.

   When one talks about the cancer, pain will be one of the most prevalent symptom (or complaint). Pain being one of the most feared and burdensome problem in cancer patients. When we speak in terms of number, 30 – 50% of patients receiving some form of therapy and 75 – 90% of patients in advanced stages of cancer will have pain.

What is cancer pain?

 In simple words, pain in patients caused by cancer disease itself and / or by the diagnostic (investigational) procedures or treatment.

Is cancer pain a Public health problem?

 Despite major improvements in pain control in the last two decades, it continues to be a challenge to treat. The available data suggests only 50% of patients with cancer are adequately treated.

How does pain develop in cancer patients?

There are various factors involved, like

• Pain caused by cancer directly (60 – 90%) – this is the more common explanation why pain develops. Here the cancer tissue either invades the neighbouring tissues like bone, bowel etc or compress (invade) the nerves, thereby causing pain.
• Pain caused by diagnostic or treatment procedures   (5- 20%) – certain procedures like Biopsy or puncture, Chemotherapy, Radiotherapy, and Surgery done by the treating doctors can be painful for the patients.
• Indirect causes (10 – 25%) – conditions like infections, lymphoedema etc can independently cause pain.
• Other associated diseases (3 – 10%) – conditions which coexist along with cancer like diabetic neuropathy, headaches, osteoarthritis etc can also give rise to pain.

These are reasons why pain develops in a cancer patient. More over there are certain ways in which cancer causes pain which is unique, like

Who will treat cancer pain?

Those were the days when your physician or surgeon used to administer the pain killer, and you will be left unsatisfied most of the times. Now we have a dedicated speciality to treat / control the pain to your satisfaction, by utilising advances in the technology non-invasive or invasive.

What are the treatment options available?

   To treat cancer pain various options are available to treating physician like,

• Pharmacological (using oral / injectable medicines)

• Interventional (using special injections to target the nerves causing pain)

What are the drugs used for management of cancer pain and what are their side effects?

Various options are available for the physician to treat the pain. Presently WHO ladder is followed for the management of pain.

Simple analgesics (pain killers) – these drugs will help to relieve the mild to moderate type of pain. These include -

• Paracetamol – commonly used, very safe drug.
• Tramadol (weak opioid)– stronger than the paracetamol, useful to treat moderate pain. It can cause nausea, vomiting and constipation.
• NSAIDs – these are a class of drugs useful to treat moderate painful conditions. Various drugs are available like, diclofenac, ketorolac,  etc.The side effects are gastric irritation, gastric bleeding, kidney problems etc.

Strong pain killers (Opioids ) - These are the drugs very similar to street drug like heroine, and are very useful in treating moderate to sever pain.

• Morphine – this drug has revolutionised the treatment of cancer pain. It is available in both tablet as well as injection form. It is available only on prescription by a registered practitioner to dispense the drug (approved by the govt). Side effects are drowsiness, nausea, vomiting, allergic reactions, itching, breathing problems etc. hence it should be prescribed by the physician.
• Others like methadone, codeine, etc are available to treat the pain.

Injectable preparations

 Drugs like morphine and fentanyl are available to treat pain in injectable forms, so that pain can be controlled in rapid and controlled manner.

What are the Interventional procedures for Management of cancer pain?

These include,

• Gasserian ganglion block – used to treat head and neck cancer pain.
• Stellate ganglion block – used in treating pain in upper limb caused by cancer of breast, lung etc.
• Celiac plexus block – used in treating pain caused by cancer of upper abdominal origin.
• Superior Hypogastric plexus block – used in treating pain of lower abdominal origin.
• Ganglion Impar block – used to treat pain arising from in around the genital region.
• Intrathecal pump implantation. etc

Where the Interventional procedures for Management of cancer pain should be done?

    These have to be done in an operating room setup where all the monitoring and resuscitation facilities are available. All these procedures require patient to adequately investigated, and admitted prior to the procedure. If required patient has to be admitted post procedure for observation.