Living with cancer

Pain control

Cancer treatment can cause pain from the disease itself, but also from the procedures necessary to fight the tumor and even the exams. Cancer pain control is part of the treatment and improves the prognosis. Learn more.
6 min de leitura
por: Grupo Oncoclínicas
Pain control
Cancer can cause pain from the disease itself, but also from the necessary procedures. Its control is part of the treatment and improves the prognosis

During cancer treatment, pain can be caused by the disease itself, by procedures to fight tumors or by diagnostic tests. The patient may also experience pain aggravated by sadness, anxiety and depression, which worsen simple conditions and need specialized attention. Cancer pain can almost always be relieved or lessened and should not be considered a normal part of the disease. It is necessary to communicate what you are feeling to the oncologist and medical team, as pain control is important for the effectiveness of the treatment. Pain-free patients sleep and eat better and maintain daily activities, including physical exercise, which contributes to the success of cancer therapy. Pain control, therefore, is part of the treatment.

Pain can be managed by the oncologist, hematologist and also by the palliative care team. Some selected cases may be referred to a pain specialist anesthesiologist.

Pains in cancer treatment according to their causes

The main pain experienced by cancer patients, according to their causes, are:

Pain caused by the tumor

Bone infiltration – is the most common cause of cancer pain. It can manifest locally or distantly and affects especially patients with multiple myeloma or bone metastases – the most recurrent are those from breast, prostate and lung tumors. Tumor growth or secondary fractures can cause injury, compression, traction or laceration of nerve structures, leading to ischemic, peripheral neuropathic or myelopathic pain;
Spinal cord compression – when a tumor invades the spine, it can put pressure on the spinal cord. The first sign is usually pain in the back of the neck or a sore throat, sometimes with numbness or weakness in an arm or leg. This compression must be dealt with quickly to prevent further consequences;
Compression or infiltration of peripheral nerves – infiltration or compression of trunks, plexuses and/or nerve roots by the tumor can determine acute and intense pain. Head and neck neoplasms or metastatic lesions to the cervical lymph nodes can compress the cervical plexuses (in the neck region), causing local pain radiating to the back of the neck or retro auricular region, shoulder and jaw;
Infiltration and occlusion of blood and lymph vessels – Tumor cells can infiltrate and/or occlude blood and lymph vessels, causing vasospasm, lymphangitis (inflammation) and possible irritation of perivascular afferent nerves. Tumor growth in the vicinity of blood vessels leads to partial or total occlusion, producing venous stasis (skin inflammation) or arterial ischemia, or both. Ischemia causes pain and lameness; and
Infiltration of hollow viscera or invasion of ductal systems of solid viscera – occlusion of organs of the digestive, urinary and reproductive systems (stomach, intestines, bile ducts, ureters, bladder and uterus) produces obstruction of visceral emptying and leads to smooth muscle contracture, muscle spasm and ischemia, producing constant diffuse visceral pain (like cramping) with heaviness. Organs such as the liver, pancreas and adrenals may experience pain.

Pain caused by surgical treatment

Surgical pain – Surgery is performed to treat cancers that have grown into solid tumors, but other treatments such as chemotherapy or radiation therapy can also be given concomitantly. Depending on the type of surgery, feeling pain is expected. However, there are medications that can be prescribed to cure or reduce pain; and
“Ghost” pain – it is also the effect of surgeries with removal of a limb, such as a leg, arm or even the breast. The patient may still feel pain or have other unusual or unpleasant sensations that seem to be coming from the missing part of the body. Phantom pain is real, not imagination. Although there are treatments, none completely relieves this type of pain. It is necessary to communicate the doctor and the pain management team.

Pain caused by other cancer treatments

Peripheral neuropathy – pain, burning, tingling, numbness, weakness or strange sensations in the hands, arms or legs and feet can be caused by some types of chemotherapy drugs (or due to vitamin deficiencies and other health problems such as diabetes and infections)
Pain in the mouth and throat – chemotherapy can cause sores and pain in the mouth and throat (stomatitis or mucositis). If the pain is severe and uncontrolled, it can prevent the patient from eating, affecting their general health; and
Pain from radiation therapy – depending on the area where radiation therapy is applied, mucositis (thrush), skin burns and other painful lesions may occur.

Pain due to procedures and exams

Tests for the diagnosis of cancer can be painful, but that cannot prevent them from being carried out. All pain can be treated and relieved.

Types of pain during cancer treatment

The intensity of pain varies from person to person and also throughout the day or night. Understanding the type of pain helps in choosing the medication to relieve it.

Acute pain – intense and lasts a relatively short time. It usually disappears as the wound heals, for example;

Chronic or persistent pain – can range from mild to severe and is longer lasting. To be considered chronic, it has to last more than three months;

Breakthrough pain – “breaks through” the relief provided by pain relievers. It usually appears quickly, lasts up to an hour and the sensation is very similar to chronic pain, but more intense. It can happen several times a day. Some people experience breakthrough pain when doing an activity like walking or getting dressed. For others, it happens without any specific cause.

Pain management in cancer treatment

Opioid drugs are often used to treat moderate and severe pain in cancer patients. These are medicines similar to endorphins, natural substances produced by the body to control pain. They must be prescribed and used with great care, due to the risks of interactions with medications or alcoholic beverages.

Not every patient has side effects associated with opioids, but when they do occur, the most common are drowsiness, nausea, vomiting and constipation in the first few days of use. Some people may also experience dizziness, itchiness, mental effects (such as nightmares, confusion, and hallucinations), slow or shallow breathing, or difficulty urinating.

You should not stop taking opioids suddenly. The decrease is gradual, with medical help, to avoid reactions such as excessive sweating and diarrhea.

Non-opioid medications control mild to moderate pain.

The most common types of non-opioid medication are dipyrone (analgesic and antipyretic, alone or to potentiate the effect of opioids), paracetamol (relieves pain, but has no ability to reduce inflammation), non-steroidal anti-inflammatory drugs – NSAIDs ( in general, should be avoided by those allergic to aspirin or any other NSAIDs, those undergoing chemotherapy, those taking steroids, lithium, blood pressure or blood thinners, those with stomach ulcers or a history of ulcers and kidney problems).

Other medications that may be used during cancer pain treatment:

Antidepressants – to treat tingling or burning of nerve origin, which can be caused by surgery, radiotherapy, chemotherapy or the tumor itself;
Antihistamines – help control nausea, sleep and control itching;
Anxiolytics – used for muscle spasms accompanied by severe pain and to decrease anxiety;
Stimulants and amphetamines – increase the action of opioids in pain control and decrease the drowsiness they cause;
Anticonvulsants – help control tingling and burning sensation of nervous origin; and
Steroids – relieve bone pain, pain caused by spinal cord compression and brain tumors, and pain caused by inflammation.

Auxiliary therapies in pain control during cancer treatment

The patient with pain must always communicate the fact to his doctor, so that he can define the best conduct. It is possible to adopt, in parallel with medication, alternative methods that help control pain. The main ones are:

• Acupuncture – can help with the control of nausea caused by chemotherapy and the pain itself;
• Massage – reduces stress, anxiety, depression, insomnia and pain;
• Meditation – has an effect on pain, anxiety and high blood pressure by relaxing the body and mind;
• Yoga – can help relieve some of the symptoms of cancer and control pain.

Myths and truths about pain and cancer treatment

The use of pain control drugs is addictive.

MYTH. This does not occur if the use is prescribed and the conduct is strictly followed by the patient.

Those who use opioids are already in the terminal stage of cancer.

MYTH. In addition to being untrue, it contributes to the stigma associated with opioids.

Patients who endure the pain are stronger and will overcome the disease more easily.

MYTH. Feeling pain without taking medication to consider yourself “strong” can even harm the treatment and jeopardize the chances of success.

Talking about pain interferes with the doctor’s decisions regarding cancer treatment.

MYTH. The specialist is trained to prescribe drugs that do not interfere with the treatment plan already in place.

Pain must be controlled from the first symptoms.

TRUTH. The sooner it is controlled, the better the patient’s quality of life and the greater the chances of successful treatment.

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