Medication for treating cancer pain
Pain caused by cancer is generally treated using strong morphine-like pain medication, i.e. opioids. They are effective in providing pain relief, even in the case of severe pain. Each patient is provided with an individual medication plan to relieve their pain as effectively as possible while also considering any other symptoms present.
Opioids are usually taken by mouth as tablets, capsules, or oral solutions. Treatment usually begins with small doses taken at regular intervals, gradually increasing the doses until sufficient pain relief is achieved. Since the severity of pain often fluctuates over the course of the day, the regularly-administered pain medication can be supplemented with a previously determined dose of rapid-acting pain medication that the patient can take in case of unanticipated acute pain. To ensure that the medication is used safely, and to stop pain from limiting one’s life, it’s important to take the medication as instructed.
The most common adverse effects of opioids include constipation and dryness of mouth. That’s why medication to prevent constipation should always be taken alongside opioids. At first, the patient may also experience nausea and fatigue, but these are usually temporary. In order to treat pain successfully, it’s important to monitor and take a preventative approach to adverse effects.
The effectiveness of pain relief is monitored by the unit responsible for the patient’s care. If taking the medicines in the doses prescribed doesn’t relieve the pain sufficiently, or if the patient experiences adverse effects, it’s advisable to contact the unit responsible for the patient’s care so that the pain management regimen can be reassessed.
If the patient is unable to swallow medicines due to problems such as nausea or weakened general condition, pain medication can be administered by other routes, such as through the skin using a patch, into a vein as a continuous infusion, or beneath the skin.
In the case of severe pain, special techniques such as spinal pain management may be used. This means inserting a catheter to administer pain medicine and anaesthetics (substances numbing the pain) into the space around the spinal cord containing cerebrospinal fluid. This technique is used to treat pain in cases such as cancer that has spread to the pelvic area.
Medicine administered either beneath the skin or into the space around the spinal cord can be given at home, once the appropriate dosage has been established. The medicine is administered using a dispenser, also known as a “pump”, that can also be used to administer additional doses (boluses) in situations such as in case of sudden pain. The dispenser fits easily into a pocket or a small bag, and therefore doesn’t prevent the patient from moving around.
Radiation therapy in cancer pain management
Radiation therapy can be effective in relieving cancer pain. Pain caused by metastases in the bones is especially often treated with radiation therapy; however, it can also be effective in the case of tumours in other parts of the body, such as the brain, lungs, skin, lymph nodes, or the pelvic area.
In many cases, just one treatment is enough to relieve pain, but sometimes several (5 to 10) treatments (also called “fractions”) are needed. The pain-relieving effects appear about two weeks after the treatment, sometimes sooner. The effects last for several months. If radiation therapy causes swelling in the tissues surrounding the tumour, pain may increase at the start of radiation therapy. It’s advisable to prepare for this with rapid-acting pain medicine, and in some cases, with a course of corticosteroids prescribed by the doctor in charge of the radiation therapy (radiation oncologist). If the pain comes back after the radiation therapy, the treatment can usually be repeated.
Radiation therapy takes place in an Oncology unit. Before the treatment, a CT scan (a computerised imaging procedure) is performed to help make a treatment plan. The treatment only takes a few minutes at a time, and the radiation cannot be seen, heard, or felt.
During radiation therapy, the patient lies still on a treatment table, often using a cast prepared in advance or a soft pad, to ensure that the patient stays in the same position during all treatment sessions. The treatment team leaves the room for the duration of the treatment, but they are monitoring the patient on a screen from another room and the patient can talk to them the entire time.
Radiation therapy requires that the patient is able to hold still throughout the treatment, understands what’s going on, and can follow instructions. A patient whose condition is very poor, or who is dying, no longer has the strength to undergo radiation therapy or gain any potential benefits. At that point, medication is used to relieve symptoms.
