From OncoLog, January 2005, Vol. 50, No. 1
DiaLog: Cancer Pain Control in the New Millennium
Allen W. Burton, M.D.,
Section Chief,
Cancer Pain Management
Department of Anesthesiology and Pain Medicine
As more and more cancer patients become long-term survivors, an interesting challenge has emerged. Historically, an oncologist’s role has been focused on treating the disease itself, but a growing area of concern today is treatment-induced chronic pain in patients whose cancer is considered cured.
Pain and symptom burden remain problematic for many cancer survivors even years after treatment, presenting physicians with a complex pain management challenge. Unrelieved pain adversely impacts the patient’s quality of life for many reasons: depression, anxiety, decreased ability to function, and inactivity-related complications such as deep venous thrombosis and pneumonia. Fortunately, as cancer treatment has evolved, so has our ability to enhance people’s quality of life at any stage of disease.
Optimum pain control includes the restoration of physical, emotional, and occupational functioning. The treatment regimen may include the judicious use of pharmacologic therapies, physiotherapy, psychological therapy, and at times interventional pain techniques such as neural blockade, neurolytic blocks, percutaneous vertebroplasty, or the implantation of a neurostimulator or pain medication infusion pump.
One of the important tools in our arsenal is the spinal administration of analgesics via an implanted pump. This implanted pain pump has been used in the treatment of unrelieved pain of various causes for over a decade, but has recently seen more diverse applications. A growing body of research shows spinal analgesia to be effective in treating many types of chronic, refractory pain, including pain from cancer.
At M. D. Anderson, our pain management group recently published our experience with spinal analgesia (Burton AW, et al. Pain Med 2004:5(3): 239-47) and found improved pain control, less requirement for oral pain medications, and importantly, a clearing of mental clouding (presumably related to the lowering of oral analgesic doses). This is concordant with other recent research, reinforcing our recommendation for the use of spinal analgesia in two broad groups of patients: (1) those with refractory severe pain in spite of numerous analgesic regimens and (2) those with mental clouding or other adverse effects of oral analgesics.
In most cases, adequate pain control can be obtained through regular assessment and application of relatively straightforward principles for the use of oral analgesics. In instances of refractory pain, effective treatment can be attained through the thoughtful application of the aforementioned multidisciplinary approach, including the use of spinal analgesia. Such measures will help physicians add quality to their patients’ lives as well as quantity.
For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.
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