Cancer-related pain can be associated with a wide range of potential causes and is highly variable from patient to patient. Fortunately, the therapies and modalities available for treating different forms of cancer pain today are equally diverse, so the vast majority of patients can get effective relief from their pain and experience the highest possible quality of life as they battle the disease.
According to Tim Kasunic, MD, of The Toledo Clinic Cancer Centers, cancer pain is usually—but not always—associated with metastatic rather than localized cancer, and the likelihood of experiencing pain depends largely on where in the body the cancer has traveled. For example, cancer that has metastasized to bone is one of the more common sources of cancer-related pain, with or without fracture. However, some primary cancers, such as brain cancer and sarcoma, can cause pain by exerting pressure on local organs or tissues.
Cancer can also cause pain due to blockages created in organs such as the colon, one of the bile ducts, or any visceral organ; bleeding into a tumor; blood clotting; or pressing on nerves and causing neuropathy.
“In addition, there’s a whole separate category of pain related to cancer treatments,” Dr. Kasunic says. “To give just a few examples, some chemo and biologic therapies can cause mucositis, or painful inflammation of the mouth; certain chemotherapy agents can cause neuropathy; and some can cause hand-foot syndrome, or painful rashes on the palms of the hands and soles of the feet. Also, radiation treatments involving the small bowel, colon, or rectum can lead to radiation enteritis or proctitis.”
As alluded above, treatments for cancer-related pain are as varied as the causes. Dr. Kasunic explains that one standard treatment is to start patients on a short-acting pain medication, usually an opioid such as morphine or oxycodone. He emphasizes that opioid addiction is a rare problem with cancer patients and that these drugs, when used properly, are safe and the most effective option for cancer-related pain. “If patients need the short-acting drug frequently, we can put them on a longer-lasting, extended-release drug, or we can put them on the extended-release drug once or twice daily along with the short-acting drug for breakthrough pain as needed. There are also various ancillary medications we can use, such as the antidepressant Cymbalta, which is very effective for cancer-related pain, as well as anti-inflammatories such as ibuprofen and steroids. For patients with nerve-related pain, we can use medications such as Gabapentin and Pregabalin along with Cymbalta,” he says.
From an interventional standpoint, there are numerous options for managing cancer-related pain as well. Among these is radiation. “The medication Xofigo, for example, is a radiation treatment infused into the bloodstream for prostate cancer with multiple bones involved. Kyphoplasty and vertebroplasty are other interventional procedures that are very effective at controlling pain in patients with spinal fractures caused by cancer. We also work very closely with interventional pain management, who offer treatments such as triggerpoint injections, nerve blocks for patients whose pain can’t be managed effectively with medications, spinal cord stimulation, and epidural infusions. Pain-management specialists are also starting to look at a new neurological procedure that destroys the part of the colon responsible for transmitting visceral pain, but this is still in the experimental stage,” Dr. Kasunic says.
Complementary therapies to reduce stress and help patients relax, such as guided imagery, aromatherapy, and massage therapy, can also be very helpful in managing cancer-related pain. Additionally, Sincera, the palliative care component of Hospice of Northwest Ohio, works closely with the care team at The Toledo Clinic Cancer Centers to assist in the management of patients’ pain and other symptoms.
Because pain is experienced differently from person to person and can develop or worsen as cancer progresses, Dr. Kasunic stresses that open, honest communication between patients and providers is vitally important in treating cancer-related pain. “If you’re experiencing pain, don’t assume it’s just something you have to tolerate. With the therapies available today, it’s very rare that we can’t find an effective way to manage it,” Dr. Kasunic says.
The Toledo Clinic Cancer Centers, located at 4126 N. Holland Sylvania Road, Suite 105, also provides imaging, laboratory, chemotherapy and IV services. The cancer center consists of 8 medical and 2 radiation oncologists along with 8 nurse practitioners and 4 research nurses. The cancer center also has satellite centers in Maumee, Napoleon, Bowling Green, Wauseon, and Monroe.
The Toledo Clinic Cancer Centers has earned Patient-Centered Specialty Practice level 3 recognition and Oncology Medical Home recognition from the National Committee for Quality Assurance. Oncology homes align systems and resources with coordinated care focused on cancer patients and their needs. This reduces fragmentation, supports shared decision making, and improves the patient experience. They are the first oncology practice in the state of Michigan and the second oncology practice in the state of Ohio to receive this recognition.
For more information, please call The Toledo Clinic Cancer Centers at 419-479-5605.