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MICHAEL AGYEMANG KUFFOUR
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
- International Association for the Study of Pain (IASP)
Not all cancer patients experience pain
INTRODUCTION
Acute pain: ranges from mild to severe.
Chronic pain: ranges from mild to severe
Breakthrough pain: is an intense rise in pain that occurs suddenly or is felt for a short time
Types of Pain
Nociceptive
pain signals from nerve endings
Neuropathic
Pain resulting from damage to nerve
Types of Pain
Moderate to severe pain experienced by 40% to 50%
of cancer patients.
Very severe pain experienced by 25% to 30% of cancer patients .
80% of terminal stage cancer experience moderate to severe pain
Do all cancer patients suffer pain ?
Infection
bradykinins, a nerve growth factor, cytokines, etc.
Tumor related
Nervous system, bone, visceral, mucosal
Treatment Related
surgery, radiation therapy, chemotherapy, interventional procedures
Causes of Pain in Cancer Patients
Detailed history
o Location ; single or multiple
o Onset and duration ; variation.
o Characterization of pain
o Aggravating and relieving factors
o Effect of medications
o Effect of pain on patient’s life.
Diagnosis
Radiation
o Relieves pain by killing cell to reduce tumor size
o promotes re-mineralisation of bone.
o predominantly used for primary tumours associated
with osteoblastic metastases
o usually delivered as external beam treatment or
systemic radioisotopes
Management of Pain
Chemotherapy
o Kill cells, reduce tumor size and reduce tumor
compression on nerves
o Not suitable in tumors which are not chemo sensitive
o It can induce pain in itself
Management of Pain
Hormone Therapy
o Used in mostly breast and prostate cancers
o useful for patients with widespread disease and
metastatic pain
o Anti estrogen and anti androgen drugs are used
respectively
Management of Pain
Biphosphonates
o Slows down the rate of growth of bone crystals and their
dissolution
o used in the management of cancer-induced bone
pain(CIBP).
o reduce morbidity from bone metastasis by reducing
skeletal events and preventing the need for radiotherapy.
Management of Pain
Surgery
o Usually required in severe and unbearable pain
o involve interruption to or modification of nerve
conduction, with the aim of diminishing pain
from a target area
o may be considered to be non-destructive or
destructive.
Management of Pain
Increase wellbeing and thus influence pain.
employed in addition to conventional treatments in
palliative and supportive cancer care.
A large proportion of cancer pain patients use CAM
Complementary Therapy for Cancer Pain
Acupuncture
This is the insertion of needles into the skin and underlying tissues for therapeutic or preventive purposes at specific sites, known as acupuncture points.
Aromatherapy
This is the controlled use of plant essences, applied either to the skin through massage, added to baths or inhaled with steaming water.
Complementary Therapy for Cancer Pain
Hypnotherapy
This is the induction of a trance-like state to facilitate relaxation and enhance suggestibility for treating conditions and introduce behavioural changes.
Massage
This is the manipulation of the bodies soft tissue using various manual techniques and the application of pressure and traction.
Complementary Therapy for Cancer Pain
Mucositis is the painful inflammation and ulceration
of the mucousmembranes, which usually occurs in the mouth but can affect other areas of the mucosa in the gastro-intestinal tract
common after radiotherapy for cancer of the head and neck and after certain types of chemotherapy, such as 5-fluorouracil
Mucositis
o meticulous oral hygiene,
o gel-based barrier protection,
o the reduction of known painful precipitants (e.g.
alcohol)
o local anesthetic mouth washes and other oral
lubricants
Non-pharmacological treatment strategies include
Neurotoxicity is a dose-limiting side-effect of many
chemotherapies and biological therapies Peripheral neuropathy is the most prevalent form of neurotoxicity.
Risk factors for the development of CIPN
Longer duration of therapy.
High cumulative dose.
Type of chemotherapeutic agent (e.g vincristine, cisplatin, paclitaxel).
Pre-existing neuropathy (including CIPN).
Chemotherapy-induced Peripheral
Neuropathy (CIPN)
o The modification of chemotherapy dosage
schedules.
o Specific preventative treatments such as
amifostine, glutathione, N acetylcarnitine, N acetyl
cysteine and glutamine/glutamate
o Vitamin E can reduce cisplatin and paclitaxel-
induced neuropathy
Prevention and treatment
WHO LADDER
Some painful conditions that are seen in cancer
patients can be successfully managed by the use of
non-analgesic drugs.
Bisphosphonates and Calcitonin are used in treating bone pain and hypercalcemia in metastatic bone disease and multiple myeloma
Steroids alleviate pain due to CNS involvement, plexus or peripheral nerve compression and visceral
organ infiltration.
Non-analgesics drugs in pain management
Muscle relaxants like Baclofen, Diazepam or
Tizanidine can be used to relieve painful muscle spasms.
Anticholinergics are used to relieve smooth muscle spasms; Hyoscine is used to relieve intestinal colic; and Oxybutinin is used for painful bladder spasms.
Calcium-channel blockers like Nifedipine are used for the management of oesophageal spasms and tenesmus
THANK YOU
