From Diagnosis to Comfort: Managing Chronic Cancer Pain in Singapore
What is Cancer Pain?
Cancer pain refers to pain caused by cancer itself or by its treatment. It can vary in intensity, duration, and type depending on the cancer's location, stage, and treatment effects. Some cancer patients experience mild, intermittent pain, while others suffer from severe, chronic pain that affects their quality of life.
What causes Cancer Pain?
Cancer pain can arise from multiple sources, including:
Tumour-Related Pain
- Infiltration or compression of nerves (e.g., tumours pressing on nerves, causing neuropathic pain).
- Bone metastases (tumours spreading to bones, causing deep, aching pain).
- Organ invasion (tumours growing into organs, leading to visceral pain).
Treatment-Related Pain
- Surgery (postoperative pain from tissue damage or nerve injury).
- Chemotherapy (can cause neuropathy, mucositis, or muscle pain).
- Radiation therapy (may result in fibrosis, burns, or chronic pain syndromes).
- Immunotherapy or targeted therapy (can trigger joint pain).
Associated Conditions
- Infections (due to weakened immunity).
- Blood clots or pressure ulcers (from prolonged immobility)
- Lymphatic blockage leading to swelling and discomfort).
Intensity of Cancer Pain
Cancer pain can vary from mild to excruciating in intensity. It can also be categorised into acute, chronic and breakthrough pain.
Acute Cancer Pain
Acute cancer pain typically presents as severe and sudden, often signalling an injury or a direct consequence of cancer or its treatment. It usually lasts for a short duration and typically resolves once the underlying issue is addressed.
Chronic or Persistent Cancer Pain
Chronic or persistent cancer pain can develop either quickly or gradually and vary in intensity from mild to severe. It is distinguished by its duration, often lasting longer than three months. Chronic pain can significantly disrupt daily life and activities if not properly managed. Management often involves regular pain medication, sometimes described as "around the clock" treatment.
Breakthrough Cancer Pain
Breakthrough pain in cancer patients is a sudden, intense flare of pain that occurs despite regular pain medication. It can arise unexpectedly and varies in intensity, often peaking quickly and lasting up to an hour. Breakthrough pain may be triggered by the same factors causing chronic pain, such as the cancer itself or treatment effects. It can also occur during certain activities or without any apparent cause. Treatment usually involves an additional or different type of pain medication tailored to address these sudden pain spikes.
Chronic Cancer Pain: Treatment & Management Methods
How to Manage Cancer Pain
Effective cancer pain management is an essential part of comprehensive patient care. Although it can be challenging, patients may find relief through a combination of medications, adjuvant therapies, or interventional pain procedures.
For Mild to Moderate Pain
Non-opioids like paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac and ibuprofen can be used. These medications are usually available over the counter and are commonly used for initial pain management.
For Moderate to Severe Pain
When dealing with such pain, opioids are frequently used. Medications in this category include codeine, tramadol, morphine, oxycodone, fentanyl, and methadone. Opioids are powerful pain medications and are typically prescribed when other pain management strategies are insufficient.
For Tingling and Burning Pain
Tingling and burning sensations are characteristic of neuropathic pain, which can occur after chemotherapy or radiotherapy. Antidepressants and anticonvulsants are effectively used in these cases. Their use does not suggest the presence of depression or epilepsy but is targeted at managing pain from nerve damage or compression.
Adjuvant Therapies for Cancer Pain
Adjuvant therapies for cancer pain, such as radiation, interventional pain procedures, and surgeries, may be offered to target the source of pain and enhance the patient's comfort and quality of life.
Radiation Therapy
Radiation therapy can be used to shrink tumours that cause pressure on surrounding tissues. It can effectively treat pain, especially when cancer has metastasised to the bones.
Radiofrequency Ablation
Radiofrequency ablation (RFA) utilises medium-frequency alternating current to generate heat that targets tumours or metastases. This technique is effective in shrinking tumours that exert pressure on nerves, bones, or organs, thereby alleviating associated pain.
Nerve blocks
Nerve blocks or neurolysis can destroy nerve signals and reduce pain from the tumour or metastases. This can be offered when the tumour is localised to an area supplied by a nerve or a group of nerves.
Intrathecal Morphine Delivery
Morphine is delivered using an automated pump directly into the spinal canal. By doing so, morphine reduces pain by activating receptors in the spinal cord.
Potential Side Effects of Cancer Pain Medication
Pain medications can cause side effects such as drowsiness, dizziness, constipation, nausea, and vomiting.
When to See a Doctor for Cancer Pain Management
It is important to seek professional help for cancer pain when:
- Your pain becomes persistent or worsens over time.
- Over-the-counter medications no longer provide relief.
- Pain interferes with your daily activities, sleep, or overall quality of life.
- You experience new or unusual pain during or after cancer treatments.