In recent years, cancer has been the main cause of death for both men and women under the age of 65 in the EU. Cancer also ranks first in deaths from all causes in Greece.12.7 million people worldwide develop cancer every year. 1.5 million suffer from bone metastases.
Pain in cancer patients is an important but undertreated problem, difficult to treat, heterogeneous in nature and severity, changing during different stages of the disease and in the course of treatment. It is acute, chronic, analgesic, neuropathic or mixed in varying degrees. It is directly related to carcinogenesis in 60-90%, indirectly in 5-20%, treatment related in 10-20% and in 3-10% coexists independently of the tumor (eg rheumatoid arthritis).
Cancer patients fear dying in pain more than dying.
The management of pain in the cancer patient is based on the assessment of the elements of pain, the cause and the mechanism in order to determine the most appropriate scheme, its correct titration, the route of administration according to the needs, habits and preferences of each patient and is subject to continuous re-evaluation , alternating or replacing drugs depending on the stage of tumor development and its treatment.
Cancer in the periphery causes pain from damage due to tissue and nerve acidification while central sensitization of the Nervous system occurs over time with a reduced threshold (increased sensitivity) to peripheral stimuli, an increase in the boundaries of the perception field (area that hurts) and increased automatic ( without stimulus) activity.
Every cancer treatment regimen is accompanied by side effects, including pain. Chemotherapy causes peripheral neuropathy but also central neurotoxicity (with symptoms such as loss of balance which increases falls and morbidity in treated cancer patients!) at a rate of 10-100% depending on the type of chemotherapy, the age of the patient, the duration of treatment and pre-existing neuropathy, affecting quality of life.
The prevention of pain caused by treatment regimens is very important, as is its subsequent treatment after its completion, in order to maintain the level of quality of life of the cancer patient. Timely referral to pain specialists and corresponding pain centers helps in optimal treatment, due to their specialized training and experience.
Interventional techniques, although they can provide significant relief especially in cases where medications fail to adequately control pain, as appears in published studies are underused, largely because the patient’s referral to a pain specialist (anaesthetist, pain medicine doctor) is delayed. Continuous infusions (subcutaneous, epidural, intrathecal, etc.) and peripheral or autonomous nerve blocks (repeated, continuous, neurolytic) depending on the experience of the pain specialist give results in all stages of the disease and treatment.
The most commonly used blocks are paravertebral, brachial plexus, and intercostal nerve blocks. Sympathetic blocks such as block of visceral nerves, abdominal plexus, hypogastric plexus are found by studies useful and effective intervention in cancer pain. The reduction in pain and the amount of opioid drugs as a result of these blocks in cases of intractable cancer pain demonstrates them as a convenient solution that is underused, probably due to the small percentage, only 3-4%, of cancer patients whose pain is treated by a specialist pain medicine doctor, who should also be trained in interventional techniques.
Statistically, 80% of cancer patients experience pain that in 50% is not effectively controlled by pharmacotherapy, while 25% of these patients die in pain.
When the pain is sufficiently controlled by the pain specialist with the most appropriate combination of all of the above Complementary treatments such as chiropractic therapy, physiotherapy, acupuncture, etc. help by improving psychology, reducing stress levels, improving sleep and mobilizing the patient.
