Struggles of Survivorship: Part 1 – Pain
It is estimated that by the year 2030, deaths due to cancer will drop dramatically and life expectancy after diagnosis will have significantly increased. Whereas this is encouraging news and proof positive that the practice of oncology and the drugs used to treat cancer have become progressively more effective, there are other factors to consider. Increased survival rates translate to more individuals living longer as survivors and the implications thereof. When one survives cancer and, hopefully, receives the seal of remission, the journey does not end; rather patients remain impacted in real and lasting ways. In many cases, cancer survivors suffer chronic pain and it is vital that they plan how best to proceed when pain threatens to overwhelm.
When Pain Remains
For survivors of cancer, pain is not solely a result of tissue damage caused by their disease. It is often the byproduct of treatment-related toxic or trauma-related damage to nerves. This damage results in long-lasting pain or even late-onset neuropathy. Pain is not always immediate and can persist after treatment or may manifest several months or even years after the end of treatment. Quite often this type of chronic pain is one of a number of symptoms including fatigue, anxiety, depression and sleep disturbance and have a negative impact on survivors’ physically and interpersonally. To combat the effects of pain, the following options represent some of the options to be used in pursuit of relief:
- Opioids: These drug therapies are certainly an option. However, when applied in the survivorship setting its use is often discouraged due to long-term side effects, including the development of opiate-induced hyperalgesia, as well as the obvious risk of abuse and addiction.
- Opioid alternatives: Physicians are now using nonsteroidal anti-inflammatory and other drugs normally used to treat other disorders. These include anticonvulsants to ease neuropathic pain, bisphosphonates for bone pain and sometimes for bone mineral loss, and antidepressants which can help with neuropathic pain, as well.
- Gene therapy represents a potentially useful, new approach but it requires careful selection of a therapeutic gene which won’t cause any further complications to the survivor. See your oncologist and ask for the most up-to-date information.
- Some patients can benefit from secondary treatments, which include nerve blocks, trigger point injections, spinal cord stimulators or implanted intrathecal pumps. These applications go directly to the sources of pain effectively turning them off and bringing relief. Nerve and tissue damage are a possibility, along with infection or bleeding as these are slightly invasive procedures, however, they’ve proved useful in restoring a better quality of life. Consult your physician and have them explain the risks and benefits.
- For those hoping to avoid a glut of drug therapies, some good results have been seen, for example with back pain at surgical sites, using stretching and training exercises to ease survivors pain along with basic nonsteroidal anti-inflammatory drugs like ibuprofen and an occasional muscle relaxant. Walking regularly paired with some more gentle training exercises appear to, in many cases, ease bone pain.
- Survivors should be encouraged to actively participate in the plan of care for their pain management, including non-pharmacologic therapies to help them focus on specific and attainable outcomes such as improved functional capacities, restorative sleep, social activities, mood and coping. These may help to reduce pain to a tolerable level and allow patients to feel they have some control over their own destinies. To be in constant pain is a depersonalizing experience, therefore the more patients can have a voice or an avenue for self-determination or actualization, the better off they’ll likely be.
Pain is a difficult, often isolating experience, therefore it is incumbent upon the physician and/or pain management specialist to help the cancer survivor get past the discomfort as best possible.
References:
https://www.cancernetwork.com/view/addressing-psychological-challenges-after-cancer-guide-clinical-practice
https://www.curetoday.com/publications/cure/2012/fall2012/managing-chronic-pain-after-cancer
https://www.everydayhealth.com/neuropathy/guide/
http://www.bayareaorthopaedics.com/specialties/trigger-point-injections
