The majority of people with cancer will present pain during the course of the disease. These pains are of varying origins, intensity and duration, sometimes complex. They may be related to cancer, treatments or certain medical and surgical procedures. To relieve patients, many opportunities exist today.
The impact of pain on quality of life
According to the National Cancer Institute, 53% of patients with cancer suffer from pain which 28% consider severe. In practice in the various treatment centers, pain is usually reported more frequently but statistics are difficult to establish. Thus, it is estimated that the majority of patients will experience pain at some point in the course of the disease and sometimes even after remission.
These pains have a very important impact on the quality of life and psychological well-being of patients who see their suffering increased by a sort of vicious circle of pain and fear. For these reasons, specialists consider that the treatment of cancer pain should be an integral and important part of the management.
Intensity, duration and type of cancer pain
According to the International Pain Association, pain is defined as “unpleasant sensation and emotional experience in response to actual or potential tissue involvement or described in these terms.”
Since pain is a subjective sensation, its intensity can be felt differently by people. In order to better understand the intensity of the pain experienced, there is a Visual Analog Pain Scale (EVA), a sort of graduated scale from 0 (no pain) to 10 (maximum pain imaginable) used by health professionals.
PAINS ACCORDING TO THEIR DURATION
Depending on its duration, there are:
- The acute pain related to a brutal achievement of tissues or organs.
- The chronic pain is evoked lasting more than 3 months of persistent or recurrent. This is known as “pain disease” because the person’s functional, relational and daily activities are affected by pain.
- The procedural pain evoked by the French Society for the Study and Treatment of Pain (SFETD) is that induced by care (blood tests, manipulations, dressings …).
THE MAJOR TYPES OF PAIN
Finally, doctors and health professionals classify pain in 3 different types:
- Nociceptive pain, caused by lesions of a part of the body (burns, fractures, inflammation …). This pain is part of our body’s warning systems to tell us that “something is wrong” and corresponds to messages sent by nervous sensors ( nociceptors ) to the nerves and the spinal cord to the brain. This pain can be constant or pulsatile.
- Neuropathic pain is caused by involvement of sensory nerves injured by crushing or tearing after trauma or by compression by a cancerous tumor. The neuropathic pain are chronic definition and perceived as electrical discharges, stabbing or burning on parts of the body corresponding to the nerve (or nerves) injured (s). These pains may persist even after the initial lesion has been resolved, as is the case with persistent pain after remission of cancer.
- Pain without an identified cause or dysfunctional pain is probably related to impaired function of pain control systems.
Cancer Pain, Complex Pain
In the case of cancer, the pain may be of varying intensity, type and duration. In the case of cancer, we speak of pain in the plural, because it is very often painful complex, with nociceptive and neuropathic components.
The pain of cancers can be linked to the cancer itself (by compression of a tumor mass, infiltration of malignant cells or metastases, etc.) but also to cancer treatments.
Indeed, many anti-cancer drugs, including chemotherapy , have a neurotoxic effect , as does radiation therapy . These treatments can therefore cause mixed pain (nociceptive at the time of treatment, neuropathic later).
Finally, manipulations, punctures and surgical procedures are all sources of pain during a cancer.
Pain and cancer, comprehensive and specialized care
Due to the complexity of the pain seen during cancer, treatment in France is done in specialized multidisciplinary centers, pain centers.
CANCER PAIN MEDICATIONS
If the painkillers given in stages help to improve the symptoms, the symptoms are often difficult to control at all stages of the disease and must therefore be reassessed in a near way.
To these analgesic medicines can be added so-called co-analgesic drugs such as antispasmodics , corticoids or muscle relaxants .
For neuropathic pain, specialists use anti- epileptics such as pregabalin ( Lyrica® ) or gabapentin .
Sometimes anxiolytics or antidepressants may be helpful.
PSYCHOLOGICAL TREATMENT FOR CANCER-RELATED PAIN
But medications are not enough to treat the complex pain associated with cancer or their treatments. It is also necessary to listen to patients, to take into account their personal, family and professional difficulties. Thus, psychological support can be as useful as analgesics. Each treatment must be made to measure, according to the needs and the profile of the patient and his entourage. The goal is to control the pain or make it bearable in everyday life so that it can impair the quality of life as little as possible.
Complementary treatments to relieve pain
In some pain centers, different techniques and alternative medicines are proposed on a case-by-case basis. Among these alternative therapeutic means, mention may be made of:
- Psychological approaches such as art therapy , the music therapy , the laughter therapy .
- The acupuncture and auricular therapy .
- The herbal medicine , but never without medical advice because plants can also have side effects.
- The homeopathy .
- The hypnosis , the relaxation and relaxation therapy .
- The reflexology .
- The osteopathy , the massages .
- The meditation , the yoga .
Many of these methods are often used simultaneously.
Specialized medical techniques
In the event of an inadequate response or in the face of rebellious pain, recent techniques can treat cancer-related pain:
- For bone metastases, very painful, it is possible to burn the area by radiofrequency and then strengthen the bone with cement.
- In case of localized pain, the areas concerned can be subjected to regional anesthesia by destroying the nerve gland that transmits the pain.
- Neuropathic pain can also be treated by transcutaneous electrical neurostimulation (NSTC).
- Metastatic pain can be relieved by high-dose radiation therapy combined with anti-inflammatory drugs .
But most importantly, in case of cancer-related pain, regardless of its intensity, type and duration, it is essential to talk to your doctor and the health care team at the pain center or oncology. Do not suffer in silence: it is essential to report your symptoms to these professionals, who today have many weapons to relieve you.
Created on May 10, 2016
National Cancer Institute. Dossier pain et Cancer ( online document ).
National Cancer Institute. Ease the pain ; quality of life.
Institut Curie. Pain, all solutions ( online document ).
The League against Cancer. How to prevent and relieve pain during cancer? 2010
SFETD (French Society for the Study and Treatment of Pain). Pain file ( available online ).
Strategies for managing cancer pain (N Cantagrel, JC Sol).