Cancer Pains

Cancer, one of the important diseases of our age, is a complex condition that causes pain in various parts of the body and sometimes causes chronic pain. Like all pains, cancer pains are a warning sign that something is going wrong in the body. Every cancer patient describes the pain they experience to different degrees. Indeed, the extent of pain experienced varies depending on the underlying cancer type and the body’s resistance.

There are 3 main reasons for cancer pain:

Pain due to invasion of the tumor, which has a 75% probability of causing cancer
Pain due to radiotherapy and chemotherapy treatments in cancer treatment with a rate of 20%
5% are due to other causes, that is, pain of completely different origin than cancer.

Localizations of Cancer Pain

Involvement in Bones: Bone pain may occur if cancer has metastasized to the bones. Bone pain complaints are present in 20-30% of lung cancers and 50-70% of breast and prostate cancers. If the cancer has metastasized to the bone, some patients may not experience pain at all. However, the pain experienced is more severe and begins at night and increases with exercise. If there is referred pain, the situation is more complicated. For example, lower back pain may be felt in the leg. If there is nerve compression pain caused by the tumor, it will give a stinging symptom.

Vertebral Involvement: It varies proportionally depending on the vertebral regions to which the cancer has metastasized. For example, 65% of the cases experience cancer-related pain in the back, 20% in the waist and pelvis, and 10% in the neck region. When there is Vertebral Involvement, the type of pain is always aching and localized. Sometimes the pain may decrease with standing and increase with sitting or pressure.

Head Involvement: There is a 50% chance of intracranial metastases and tumors in cancer patients. Approximately half of them have headache complaints. Conditions such as visual disorders, neuropsychiatric diseases and hemiparesis may also be observed along with cancer and metastasis.

General Pain Control in Cancer Patients

Pain that occurs as a result of some complex treatments applied to cancer and the metastasis of cancer must be controlled by specialist physicians. You should explain your pain description clearly and clearly to your doctor. Your physician will apply the most effective treatment to you. Do not hesitate to use various analgesic medications to relieve pain. Very rarely, resistance develops in the body against analgesics.

Pain Management in Cancer

The World Health Organization says that approximately 80% of cancer pain can be controlled. In this way, the quality of life of patients will increase.

In order to effectively control cancer pain, a detailed evaluation must first be made by the physician. In-depth information should be obtained about the cause, type and location of the pain, as well as when the pain started and its severity. The patient’s statement is extremely important in this case. If the patient says “I have pain”, effective treatment methods must be started. The patient should be checked at regular and frequent intervals. If the medications given are not sufficient, the dose should be increased or the medication changed. If treatment is started parenterally first, then oral or transdermal methods should be preferred. The patient’s relatives should also be active in the treatment process and explain to the patient that their pain will ease, if not go away completely. It is very important that the patient is evaluated objectively using numerical pain scales during check-ups by the physician.

Pain Intensity in Cancer

The basic mechanism in the treatment of cancer pain; is to determine the severity of pain and then take it under control. We can achieve this by communicating with the patient in a coordinated manner. Although pain is described subjectively by the patient, treatment can be planned according to the severity of pain by using various numerical, verbal and visual scales. While no pain is evaluated as 0 (zero), unbearable pain is evaluated as 10 (ten).

Inadequacies in Pain Control in Cancer

Pain experienced by cancer patients cannot be adequately controlled in oncology and algology clinics. The reasons for this include the following:

Reasons related to the patient
Failure to apply treatment methods correctly due to not knowing exactly the treatment options
Fear of death that may occur in the patient
Low dose analgesic therapy
Reasons arising from the health system or physician

Pain Treatment in Cancer

Although the World Health Organization offers stepwise treatment methods for cancer pain to the whole world, the pain cannot be controlled because it cannot be applied sufficiently. The main goals in pain treatment are as follows:

Ensuring optimal pain control
Applying the treatment that will cause the least side effects
Improving the patient’s general condition
Raising the standard of living

There are many methods that physicians can apply to treat cancer pain. In general, the least invasive and most effective treatments are planned. In cases where it is inadequate, more invasive treatments are preferred.

Direct treatment methods for cancer include:

Surgical
Chemotherapy
Radiotherapy
Palliative treatment
endocrine therapy
Radioisotope therapy
Pharmacological treatment
Physiotheraphy
Aromatherapy vs.

Pharmacological Treatment for Cancer Pain

There is “analgesic staircase treatment”, which is widely used in cancer pain and recommended by the World Health Organization.

The important thing in step treatment is medication;

on time
Oral
It is to apply in appropriate doses.

If such a treatment is applied completely, approximately 80% of the pain can be controlled and patient comfort can be ensured.

The most important purpose of step therapy is to increase its usability in cancer pain. In the first step, treatment can be started with non-opioid and non-steroid anti-inflammatory drugs. Then, in the second step, a mild opioid such as codeine should be preferred in addition to the first step. If pain persists, strong opioids such as morphine should be used. The biggest mistake of those who provide treatment is that they always start treatment from the first step, no matter what level of pain the patient is experiencing. But this is extremely wrong. Treatment should be started at the appropriate level, taking into account the patient’s pain scale.

Step Treatment

First line: nonopioid+adjuvant

Second step: nonopioid+adjuvant+weak opioid

Third step: nonopioid+adjuvant+strong opioid

Factors That Increase the Chance of Success of Step Treatment

Systemic analgesics should be given by the appropriate route, in the correct dose and at certain intervals.
Unless oral medication intake is contraindicated, oral medication should be the first choice.
Treatment should be started with non-opioid drugs, but if the pain does not subside, adjuvant drugs should be combined.
The patient’s pain scale must be taken into consideration and the treatment step must be chosen accordingly.

Nonopioid drugs

acetaminophen
Aspirin
Diflucinal
ibuprofen
indomethacin
naproxen

Opioid Drugs

Morphine
hydromorphine
fentanyl
tramadol
levorphanol
Codeine
methadone

Side Effects of Opioids

Opioids, which are indispensable drugs in the treatment of cancer pain, have some side effects. These;

Nausea
Vomiting
diarrhea
Itching
Neuropsychiatric disorders
Dizziness
urinary retention
confusion
Excessive shrinkage of the pupil
Myoclonic jerks occur.

Interventional Analgesia Methods in Cancer Treatment

Analgesic and opioid drugs used in the stepwise treatment determined by the World Health Organization may be ineffective in some cases. Since the pain threshold will increase as the disease progresses, interventional analgesia methods, especially spinal opioid applications and nerve blocks, can be tried.

Interventional treatment methods are used on patients who cannot benefit from step treatment, patients who cannot use medication due to side effects, patients with high pain scores, and patients who do not want to be involved in any step treatment.

Contraindications are as follows:

Bleeding disorders
Infection
Patient’s rejection
The patient is not well enough to afford the treatment
Contraindications arising from the intervention.

Interventional Analgesic Techniques

nerve blocks
Radiofrequency thermocoagulation methods
Epidural, intrathecal, intraventricular opioid
Alcohol and glycerol treatment to the pituitary
Spinal cord stimulation