Cancer pain

Unfortunately cancer is often associated with significant pain as adjacent tissue is destroyed by the cancerous tumor. Specific treatments for cancer are directed at the underlying cause of symptoms. When a nerve is being compressed by the direct growth of a tumor, treatment of that nerve injury may be helpful. For instance, radiation or chemotherapy may help shrink the tumor and therefore may help to control the pain. When this does not help or is not an option (i.e. – too much radiation already), then direct injection of the compressed nervous structure or of the nerves innervating that tissue, may be helpful. In extreme cases the nerve can be permanently destroyed, chemically (most commonly with the injection of alcohol or phenol). Pancreatic cancer, which is associated with severe abdominal pain, is often well treated with a neurolytic injection of the celiac plexus (a group of nerves within the abdomen that innervate the pancreas). When the tumor is causing fracture of the bone, or other soft tissue injury, the use of narcotic or opioid medications may be helpful. These may be delivered orally or intrathecally, through an implanted pump. This latter option is a more sophisticated interventional pain technique which is effective for more severe and recalcitrant cases. At least one study has shown that the better pain control which can be achieved with implanted spinal drug delivery devices has been associated with improved survival and prolonged life. This is believed to be due to the body’s ability to then concentrate its energy on fighting the disease rather than the pain. We are happy to explore with cancer patients the various treatment options that are available to them.