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Cancer pain management aims to alleviate suffering and improve quality of life through a tailored, multidisciplinary approach involving medication, interventional procedures, and supportive therapies.
1. Pharmacological Management
Medication remains the foundation of treatment, often guided by the WHO Analgesic Ladder, which matches drug strength to pain severity.
- Mild Pain: Managed with non-opioids like acetaminophen (paracetamol) or NSAIDs (e.g., ibuprofen, naproxen).
- Moderate to Severe Pain: Treated with opioids. Morphine is the standard first choice, but others like oxycodone, fentanyl (patches), hydromorphone, and buprenorphine are common.
- Adjuvant Medications: These enhance pain relief or target specific types of pain:
- Nerve Pain: Anticonvulsants (gabapentin, pregabalin) or antidepressants (amitriptyline, duloxetine).
- Bone Pain: Bisphosphonates or steroids (dexamethasone).
- Inflammation/Swelling: Corticosteroids.
- Breakthrough Pain (BTP): Sudden spikes in pain are managed with “rescue” doses of immediate-release, rapid-onset opioids.
2. Interventional Procedures
When medication is insufficient or causes intolerable side effects, interventional techniques can block pain signals.
- Nerve Blocks: Injections of local anesthetics or neurolytic agents (alcohol/phenol) near nerves to stop pain transmission. Common for abdominal (celiac plexus block) or head and neck cancers.
- Intrathecal Drug Delivery (Pain Pump): A surgically implanted device delivers medication directly into the spinal fluid, allowing for much lower doses and fewer systemic side effects.
- Vertebroplasty/Kyphoplasty: Minimally invasive procedures to stabilize painful vertebral fractures caused by cancer.
- Cordotomy: A procedure that disables the spinothalamic tract in the spinal cord; typically reserved for severe, unilateral pain in patients with a short life expectancy.
3. Non-Pharmacological & Supportive Care
Integrating lifestyle and mental health strategies can reduce the emotional burden of pain.
- Mind-Body Techniques: Mindfulness, meditation, and guided imagery can reduce anxiety and perceived pain intensity.
- Physical Therapy: Gentle exercise, massage, and TENS (electrical nerve stimulation) help maintain mobility and reduce stiffness.
- Radiation Therapy: Specifically used to shrink tumors that are pressing on nerves or bones, providing significant relief for bone metastases.