Methods that are good for cancer pain: These pains can be controlled with nerve blocks, radio frequency or epidural catheter applications. Here are the details…
Many types of cancer, which are rapidly spreading in our country as well as all over the world, can be treated thanks to today’s medical and technological opportunities. Cancer, which is one of the diseases that can cause life-threatening risks, can cause pain that negatively affects the patient’s quality of life during the treatment and diagnosis process. Strong painkillers used to relieve these pains can cause side effects such as sleepiness, dizziness, nausea and vomiting in the patient.
Experts from the Algology (Pain) Polyclinic gave information about the interventional procedures applied to cancer pain.
Cancer can cause pain in different parts of the body depending on its type
Cancer, one of the leading diseases that can cause life-threatening risks, can be seen in every person today, regardless of age and gender. However, due to the fact that cancer is so fast and widespread, there are also important developments in treatment practices. In cancer treatment, patient comfort during the treatment process is as important as early diagnosis and early treatment. Depending on the type of cancer, the patient may experience severe pain in various parts of his body during the treatment process, and the strong painkillers he uses to relieve these pains may have side effects. Lung cancer can cause severe back pain, and cancers originating from our internal organs such as pancreas, liver and stomach can cause severe abdominal pain.
A patient-specific treatment plan is made
Cancer pain may vary depending on the type of cancer, its stage, other health problems the patient may have, and pain threshold. Destruction of normal tissues due to cancer, circulatory disorders due to blockage in blood vessels, metastases, infections or surgical operations during the treatment process, chemotherapy and radiotherapy used in treatment can also cause some pain in the body. Cancer pain is planned according to the patient’s pain threshold. Stepwise treatment has been determined by the World Health Organization for the treatment of cancer-related pain according to the severity of the pain. For example, patients experiencing mild pain are treated with medication. In cases where drug treatment is insufficient or ineffective, these pains can be alleviated or completely eliminated with interventional procedures performed depending on the cause of the patient’s pain.
Pain in cancer patients can be minimized with interventional procedures
Some interventional procedures performed by Algology (Pain) specialists specific to the type of cancer, the area where the pain is caused and the patient are as follows:
Nerve blocks:
The patient’s nerves causing pain are identified and pain transmission is stopped with some medications. For example, the nerves that carry the pain sensation of the abdominal organs unite in a ball in front of our spine, and this nerve ball is called the Coeliac ganglion. Severe abdominal pain can be prevented with an interventional procedure performed through a needle by targeting this bundle of nerves. The patient can be discharged on the day of the procedure and continue his normal life.
The coeliac plexus is a complicated web of nerves at the back of the abdomen. It can cause ongoing pain in people with pancreatic cancer and some other types of cancer in the abdominal area.
To block the pain, you can either have:
- an injection into the nerve
- a small operation to cut the nerve
Injection into the nerve
For a nerve block using an injection, the doctor injects either local anaesthetic (with or without steroids), or alcohol into the coeliac plexus. Alcohol gives a longer lasting block.
You’ll probably have medicine to make you drowsy (sedation) before this procedure.
First, you have a small injection of local anaesthetic to numb your skin. The doctor then puts a long needle in through your back or chest to the coeliac plexus. During the procedure, you have x-rays or CT scans so your doctor can check the needle is in exactly the right place.
In some cases, you may have the needle put into the coeliac plexus through the stomach wall during an endoscopy.
Research has shown that up to 9 out of 10 people (up to 90%) with abdominal cancers can get short and long term pain relief with a coeliac nerve block.[1]
Neurolysis:
Like a nerve blockade, the nerve causing pain is targeted with a needle. However, this time, the targeted nerve is damaged with some special chemical agents and the pain transmission of the nerve is prevented for a longer period of time.[2]
Radiofrequency treatment:
Cancerous tissue is transmitted to the spinal cord and then to the brain via some nerves, creating pain. The nerves, which can be considered as intermediate stops and through which pain is transmitted to the spinal cord, are approached with a radiofrequency needle and these nerves are damaged through heat, preventing the transmission of pain to the spinal cord. Thus, patients’ pain is prevented for a long time.[3]
Epidural catheter application:
In this method, which is well-known to the society due to painless birth, a very thin catheter is placed on the back wall of the spinal cord and tunneled under the skin, making it usable for a longer time. From here, pain is stopped at the spinal cord level with continuous or intermittent drug applications.[4] With the epidural catheter, much lower doses of strong drugs that need to be taken orally in high doses due to pain and which can have serious side effects are administered this way, thus reducing the side effects associated with the use of painkillers.
Epidural / Spinal Port applications:
In this method, the catheter placed behind the spinal cord, that is, epidural or directly inside the spinal region, is connected to the chamber, that is, the port, placed under the skin, with a method similar to the chemotherapy port. Through this pain treatment port, which is similar to the vascular port in chemotherapy application, very low doses of painkillers are administered as intermittent or continuous infusion. With this method, the pain experienced by the patient who is discharged on the same day is completely eliminated or minimized.
Many methods similar to these can be applied to almost all cancer patients, depending on the type of cancer, location, shape and severity of pain.
References:
- Cancer Research UK. Nerve Blocks
- Koyyalagunta D, Burton AW. The role of chemical neurolysis in cancer pain. Curr Pain Headache Rep. 2010 Aug;14(4):261-7. doi: 10.1007/s11916-010-0123-9. PMID: 20524161.
- Patti JW, Neeman Z, Wood BJ. Radiofrequency ablation for cancer-associated pain. J Pain. 2002 Dec;3(6):471-3. doi: 10.1054/jpai.2002.126785. PMID: 14622733; PMCID: PMC2408947.
- Smitt PS, Tsafka A, Teng-van de Zande F, van der Holt R, Elswijk-de Vries I, Elfrink E, van den Bent MJ, Vecht CJ. Outcome and complications of epidural analgesia in patients with chronic cancer pain. Cancer. 1998 Nov 1;83(9):2015-22. PMID: 9806662. https://pubmed.ncbi.nlm.nih.gov/9806662/