Cancer Pain and Its Causes
Cancer pain is experienced by many patients and can vary widely in terms of severity and type. It may be intermittent or persistent, mild or severe, and it may affect one or several parts of the body. It often occurs when a tumour applies pressure on bones, nerves, or organs, causing discomfort that varies according to the tumour’s location. For example, a small tumour near a nerve or the spinal cord can be excruciating, while a larger tumour in a different location may not cause any discomfort.
Moreover, cancer treatments, such as chemotherapy, radiotherapy, and surgery, can also lead to pain. For example, radiotherapy can cause skin irritation and chemotherapy can cause burning pain or numbness in the hands and feet. The potential of developing certain painful conditions often increases in patients with a suppressed immune system, a common consequence of these therapies. Post-operative pain is another common concern, and effective relief can contribute to a faster and more effective healing process.
Methods of Cancer Pain Relief
Contrary to popular belief, cancer pain can be alleviated. Approximately nine out of 10 patients find relief using a combination of medications. The type and severity of the pain dictate the choice of medication.
- For mild to moderate pain: Non-opioids like acetaminophen paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can be used. These are often available over-the-counter without a prescription.
- For moderate to severe pain: Opioids like hydromorphone, hydrocodone, codeine, tramadol, morphine, oxycodone, fentanyl, and methadone are generally employed.
- For tingling and burning pain: Often associated with chemotherapy and radiotherapy, antidepressants and antiepileptics can provide relief. The use of such medications does not signify that the patient is depressed or at risk of seizures. These medications effectively manage neuropathic pain, often resulting from nerve compression or invasion by tumours.
Pain caused by inflammation and swelling can be treated with steroids like prednisone and dexamethasone.
Potential Side Effects of Cancer Pain Medication
While pain medications are generally effective, they may cause side effects such as drowsiness, dizziness, constipation, nausea, and vomiting. Should these side effects occur, a discussion with your doctor can help adjust the medication or dosage to minimise the discomfort and maximise pain relief. Our specialists at The Pain Clinic are always prioritising the patient’s comfort and well-being, always working to find the most suitable solution for each individual case.
What if I Still Have Pain After Taking Medication?
In some cases of advanced or metastatic cancer, traditional pain medication might not be adequate. This usually happens when the cancer has spread to multiple parts of the body. In such scenarios, a method known as intrathecal drug delivery can be used for effective pain management. This method involves a minor surgical procedure to place a drug reservoir under the skin, which infuses a combination of morphine and local anaesthetic into the intrathecal space surrounding the spinal cord through a small tube or catheter. This provides direct relief to the pain-affected area, thus managing pain more effectively. If you’re interested in learning more about this pain management method, Medtronic provides additional information about the cancer pain pump used in intrathecal drug delivery.
Consultation and Personalised Cancer Pain Management
Cancer pain is unique to each individual, and so should be the approach to managing it. At The Pain Clinic, we tailor treatment plans for cancer pain management to address your specific needs. Don’t let cancer pain dominate your life. Schedule a consultation today, and let us help you on your journey towards effective pain management and improved quality of life.
Meet Our Doctor
Dr Ho Kok Yuen is a specialist in pain medicine and anaesthesia. He completed his pain management fellowship at Duke University Hospital in USA in 2006. He is involved in teaching, research and also serves on numerous advisory boards. Besides writing articles in peer-reviewed journals, clinical practice and consensus guidelines, as well as book chapters on pain and anaesthesia, he lectures at international conferences and teaches at interventional pain workshops frequently.
Dr Ho Kok Yuen obtained his MBBS and Master of Medicine (Anaesthesiology) from the National University of Singapore. He holds a Graduate Diploma in Sports Medicine (GDSM) from the Lee Kong Chian School of Medicine (LKCMed) at Nanyang Technological University.
Education
- Diplomate, American Academy of Pain Management (DAAPM)
- European Diploma in Pain Medicine (EDPM), European Society of Regional Anaesthesia (ESRA)
- European Diploma in Pain Medicine (EDPM), European Pain Federation EFIC
- Graduate Diploma in Sports Medicine, Lee Kong Chian School of Medicine (LKCMed)
Credentials
- Chairman, Chapter of Pain Medicine Physicians, Academy of Medicine, Singapore
- Council Member, College of Anaesthesiologists, Academy of Medicine, Singapore
- Chairman, South-East Asian Section, World Institute of Pain (WIP)
- Fellow, Interventional Pain Practice (FIPP) with the WIP
- Examiner, FIPP Examinations
- Fellow, Academy of Medicine, Singapore (FAMS)
- Past President, The Pain Association of Singapore (2011-2017)
- Past Vice-President, Association for South-East Asian Pain Societies (ASEAPS) (2012-2013)
Area of Expertise
Dr Ho Kok Yuen is widely recognised as an expert in minimally invasive interventional pain management, having performed thousands of such surgeries. He treats persistent and severe pain using therapies such as steroid injections, nerve blocks, radiofrequency ablation, intrathecal drug delivery and spinal cord stimulation.
The first physician in Asia to perform cooled radiofrequency ablation, he has been treating spine, sacroiliac joint, hip, and knee pain using this technique since 2006. He also administers spinal infusions to ensure pain-free end-of-life comfort care for patients with advanced terminal cancer pain.
When Boston Scientific launched its most advanced SCS system – the WaveWriter Alpha™ – in Southeast Asia, Dr Ho Kok Yuen was the first doctor to perform the implant surgery. SCS uses electrical impulses to block pain signals in the spinal cord, effectively treating intractable back pain, leg pain and neuropathic pain. SCS therapy has helped hundreds and thousands of people around the world improve their quality of life.
Frequently Asked Questions About Cancer Pain Management and Relief
1. How does cancer cause pain?
Cancer often results in pain as the disease progresses, necessitating effective cancer pain relief strategies. This pain can arise from various sources, most commonly when a tumour grows and exerts pressure on nearby organs, bones, or nerves. The extent and nature of the discomfort may vary based on the tumour’s location and size. In addition, treatment modalities like chemotherapy and radiotherapy can introduce their own forms of discomfort, further emphasising the need for comprehensive cancer pain management.
2. How can cancer pain be treated and managed in cancer patients?
Cancer pain relief involves a multi-faceted approach that is customised for each patient. Often, stronger painkillers such as opioids, including morphine, oxycodone, fentanyl are needed to manage cancer pain effectively. For nerve-related pain caused by tumours compressing nerves, medications such as anti-convulsants or anti-depressants may be more effective.
3. Are there side effects to painkillers?
Yes, painkillers, particularly opioids used in cancer pain management, can have side effects. These may include drowsiness, dizziness, constipation, nausea, and vomiting. It’s essential to communicate with your healthcare provider about these side effects, as alternatives or additional medications can help manage them.
4. What if I still have pain after taking painkillers?
Even with the administration of painkillers, some patients may continue to experience pain, particularly in cases of advanced or metastatic cancer. This can happen when the cancer has spread to many parts of the body or has affected the nervous system. If this occurs, more potent interventions may be necessary. One such method is intrathecal drug delivery, a specialised procedure that delivers pain medication directly into the fluid surrounding the spinal cord. This involves a minor surgical procedure to implant a drug reservoir under the skin. The reservoir infuses medication like morphine and local anaesthetics through a small catheter into the intrathecal space, providing more effective pain relief.