Chronic Cancer Pain
Chronic cancer pain, a significant issue for individuals coping with cancer, varies widely in its manifestation. This pain, which may be intermittent or constant, and range from mild to severe, can arise from various aspects of cancer and its treatment.
In Singapore, addressing chronic cancer pain is a critical component of oncology care. Medical professionals, including pain specialists, develop holistic treatment plans that integrate both pharmacological and non-pharmacological approaches. Tailoring these strategies to individual patient needs is pivotal in enhancing quality of life, focusing on pain management and its underlying causes. This patient-centred approach acknowledges the complexity of cancer pain, striving to provide relief and support to those affected.
Cancer Pain and Its Causes
Chronic cancer pain, a significant issue for individuals coping with cancer, varies widely in its manifestation. This pain, which may be intermittent or constant, and range from mild to severe, can arise from various aspects of cancer and its treatment.
In Singapore, addressing chronic cancer pain is a critical component of oncology care. Medical professionals, including pain specialists, develop holistic treatment plans that integrate both pharmacological and non-pharmacological approaches. Tailoring these strategies to individual patient needs is pivotal in enhancing quality of life, focusing on pain management and its underlying causes. This patient-centred approach acknowledges the complexity of cancer pain, striving to provide relief and support to those affected.
Intensity of Cancer Pain
Cancer pain arises from a variety of sources. It’s not just the direct impact of the disease on tissues, nerves, or organs that causes discomfort, but as mentioned above, the effects of treatments as they can potentially lead to neuropathic pain and inflammation. In addition, surgical procedures can also cause post-operative pain in and around the surgical site. Understanding these factors is crucial in forming tailored pain management strategies for each patient.
Intensity of Cancer Pain
The intensity of cancer pain can vary from mild to excruciating, with varying levels of impact on one’s quality of life. Three types of pain are typically observed in cancer patients: acute, chronic, and breakthrough pain. The following sections will described the pain types, as well as management methods for relief.
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. This pain type is usually of short duration, subsiding as the underlying issue, such as a procedure-related injury or the effects of treatment, is resolved. Effective management of acute pain is crucial, focusing on rapidly addressing the cause and alleviating discomfort to maintain patient comfort and facilitate ongoing treatment.
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 persisting for 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, aimed at lessening or controlling pain to improve the patient’s quality of life.
Breakthrough Cancer Pain
Breakthrough pain in cancer patients is a sudden, intense flare of pain that occurs despite regular pain medication for chronic pain. 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. Management of such pain is crucial, as it is not typically controlled by regular pain medication doses. Treatment usually involves an additional or different type of pain medicine, tailored to address these sudden pain spikes effectively.
Methods of Cancer Pain Relief
Effective management of cancer pain is a key component of comprehensive patient care. While managing cancer pain can be challenging, patients can potentially achieve relief through various medications, tailored to the type and severity of their pain.
- 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 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 hydromorphone, hydrocodone, codeine, tramadol, morphine, oxycodone, fentanyl, and methadone. Opioids are powerful pain relievers and are typically prescribed when other pain management strategies are insufficient.
- For tingling and burning pain: For neuropathic pain, which is often characterised by tingling and burning sensations, particularly following chemotherapy or radiation therapy, antidepressants and antiepileptics can be beneficial. It’s important to understand that the use of these medications in pain management does not imply the presence of depression or a risk of seizures. Instead, they are effective in addressing pain resulting from nerve damage or compression.
In cases where pain is caused by inflammation and swelling, corticosteroids like prednisone and dexamethasone may be prescribed. However, it’s critical to consider potential contraindications when using these medications, especially opioids, antidepressants, antiepileptics, and steroids. A contraindication refers to a specific situation or condition in which a drug should not be used, as it could be harmful to the patient. This is why proper medical supervision is essential, ensuring the safe and effective use of these drugs. Healthcare professionals can identify any contraindications based on the patient’s medical history, current medications, and overall health condition, thereby preventing adverse side effects and interactions with other medications.
Potential Side Effects of Cancer Pain Medication
In Singapore, pain care for cancer patients, overseen by specialists, involves strict adherence to regulatory standards for the safe administration of pain medications. These medications, while crucial for pain relief, can lead to side effects such as drowsiness, dizziness, constipation, nausea, and vomiting. Patients in Singapore receiving such care are advised to stay informed about these potential side effects and to consult with healthcare specialists if they experience them.
Licensed healthcare professionals in Singapore, specifically those qualified in pain management and oncology, are adept at managing the side effects of cancer pain medications, and will carefully adjust the medication’s dosage to suit the individual patient’s needs. This expert approach, undertaken by qualified medical practitioners, is a crucial aspect of pain care in Singapore, reflecting a dedication to combining effective pain management with a high standard of patient safety and comfort.
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 therapy might be used for the management of pain. 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.
Consultation and Personalised Cancer Pain Management
Effective management of cancer pain hinges on an individualised approach, recognising that each patient’s experience with pain is unique. Specialised pain management clinics, play a crucial role in developing treatment plans that cater specifically to the diverse needs of patients.
The process typically begins with a thorough assessment, focusing on understanding each patient’s particular pain patterns and overall health. This initial step is vital, as it guides the formulation of effective pain management strategies.
Adhering to Singapore’s medical guidelines, various treatment options aimed at pain relief and improving the quality of life for patients will be offered. The priority is to ensure that each patient receives care that is tailored to their specific medical and personal needs, reflecting a commitment to patient-centred cancer pain management.
Our clinic is under the following insurance panels
We work with various insurance partners to assist with your hospitalisation and surgery claims. In some instances, pre-approval from your insurer allows direct billing between the hospital and insurer so that you will have peace of mind during your treatment. We are accredited by Singapore’s Ministry of Health (MOH), so you may also utilise Medisave for your hospitalisation expenses.
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?
In managing cancer pain, recognising that the disease can lead to significant discomfort is essential. This pain often arises from various sources. For example, as tumours expand, they may press against organs, bones, or nerves, causing varying degrees of pain. The spread of cancer to other body parts can also lead to discomfort. In Singapore, where a range of cancer treatment options like chemotherapy and radiation therapy are available, side effects from these treatments can further contribute to the patient’s pain. Effective cancer pain relief in this instance involves personalised strategies, developed by healthcare professionals, to address these diverse sources of pain, enhancing the patient’s quality of life.
2. How can cancer pain be treated and managed in cancer patients?
Cancer pain management in Singapore involves a personalised, multi-faceted approach. Pain specialists often prescribe opioids such as morphine, oxycodone, and fentanyl, for chronic pain relief. These medications are controlled substances and are prescribed with caution, requiring close monitoring due to potential risks and side effects. For neuropathic pain, which can result from nerve compression or damage by cancer, treatment may include anti-convulsants or anti-depressants.
3. Are there side effects to painkillers?
Yes, painkillers, particularly opioids used for cancer pain management, can have side effects. Common side effects include drowsiness, dizziness, constipation, nausea, and vomiting. It is important for patients to communicate openly with their healthcare providers about these side effects. This is important, as the healthcare team can then adjust the medication regimen or suggest additional treatments to manage these side effects effectively, ensuring the patient’s comfort while maintaining pain relief.
4. What if I still have pain after taking painkillers?
For some cancer patients, pain may persist even after the administration of painkillers, especially in cases of advanced cancer. This situation can occur when the cancer has spread extensively or has affected the nervous system. In such scenarios, stronger or alternative pain management methods may be required. One such method is intrathecal drug delivery. This procedure involves a minor surgery to implant a drug reservoir that delivers pain medication directly into the spinal fluid to provide additional pain relief. This method is used under strict medical supervision and is considered for patients with complex pain management needs.