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Cancer Pains

As advances in cancer detection and therapy are extending the life expectancy of cancer patients, there is an increasing focus on improving their quality of life. Almost 30-50% of all cancer patients will have moderate to severe pain, while in advanced or metastatic cancer 75-95% will experience significant pain. According to western data, almost 45% of cancer patients have inadequate or under-managed pain control.

Th treatment of cancer pain can involve a variety of modalities which might be targeted at reducing the size of tumour such as radiotherapy, chemotherapy and surgery, which have their own side-effects. The causes of under treatment of cancer pain includes inadequate assessment, poor access and side effects of above mentioned treatments.

The patient with cancer pain typically presents a complex pain syndrome composed of multiple physical causes. Anger, anxiety and depression are also common accompaniments and also need to be managed to reduce the sufferings of these patients.

The treatment of cancer pain is therefore be multimodal incorporating optimal combinations of analgesics, adjuvant analgesic drugs, psychological and sociological support and other specific treatments. Also as the disease is a dynamic process which will evolve from day-to-day, the treatment modalities are reviewed and newer modalities are added whenever required.

Most patients will require treatment with medicines which includes analgesics and adjuvant drugs. Analgesics are prescribed as per the WHO algorithm with opioids like morphine being the mainstay in moderate to severe pain. Adjuvant analgesics include NSAIDs, Psychotropic drugs such as anticonvulsants, antidepressants, corticosteroids etc.

Interventional pain procedures do have their role in managing some of the cancer pains and should be resorted to earlier rather than late. Visceral pains such as upper abdomen pain secondary to pancreatic, gall bladder and gut malignancy, pelvic pain, neuropathic pains secondary to cancer may respond to interventional procedures.

Neurolytic blocks are given commonly for managing cancer pain. These include Coeliac plexus block, Splanchnic block, Superior hypogastric block, Ganglion impar block etc.

Alcohol, Phenol, glycerol are the usual neurolytic agents which are used in such blocks.

In cases of Neuropathic pains such as brachial plexopathy secondary to breast cancer or lumbar plexopathy, a transforaminal epidural injection or a Pulsed Radiofrequency of dorsal root ganglion is known to provide pain relief if not responding to conservative management. The psychological and social support and specific cancer treatments such as chemotherapy or radiotherapy or surgical excision do have effect to reduce the cancer pain and associated sufferings.