Cancer pain affects millions of individuals worldwide. According to a 2022 systematic literature review and meta-analysis, approximately 30.6% of cancer patients (or 30 out of 100 people) live with moderate to severe pain, whether due to the disease itself or the side effects of certain treatments. Similar to how breast cancer death rates are down by 58% due to advancements in screening technologies and treatments, the meta-analysis’s findings imply that the prevalence of pain and pain severity has declined in the last decade. Nonetheless, countless patients still live with cancer-related pain.
New Hope Unlimited’s Thoughts on Cancer Pain Management
As medical professionals, we understand that managing pain is crucial for enhancing the quality of life for patients undergoing cancer treatment. Even in survivorship, some men and women have reported feeling “torturous discomfort.”
Whether the sensation arises from cancer or as an aftereffect of treatments, pain can impact a patient’s physical and emotional well-being. Effective pain management, however, is not a one-size-fits-all solution. It demands a comprehensive understanding of the types of pain, its causes, and the available treatment options.
In this writing, we will explore two primary approaches to managing cancer pain: conventional and alternative methods. Conventional pain management typically involves using Big Pharma medications, including over-the-counter painkillers, narcotics, and corticosteroids. On the other hand, alternative pain relievers encompass a multiplicity of therapies, including but not limited to acupuncture, massage therapy, and mind-body techniques. The purpose of this article is to provide a detailed comparison of both approaches.
What Is Cancer Pain?
In many cases, the discomfort associated with cancer and specific treatments is controllable. Numerous medications and techniques from both sides of medicine have been developed to manage cancer pain. To address it effectively, patients and caregivers must equip themselves with knowledge about the types of cancer pain, their underlying causes, and how they impact daily living.
What Are the Types of Cancer Pain?
Cancer pain can be categorized into three general types: acute, chronic, and breakthrough pain.
- Acute pain: This type of pain is often sudden and severe. It typically results from injury or an invasive procedure, but resolves once the underlying cause is attended to. For cancer patients, acute pain might occur after surgical procedures or during certain diagnostic tests. Some diagnostic tests that might cause temporary, short-term pain include biopsy, mammography, colonoscopy, and cystoscopy.
- Chronic pain: Unlike acute pain, chronic pain persists over a longer period, often lasting more than three months. In cancer patients, chronic pain can result from the tumor pushing or pressing on nerves, bones, or organs. It can also arise from treatment-related side effects such as neuropathy from chemotherapy. About 30 to 40% of cancer patients experience a form of neuropathy during or after a chemo session. The hands and feet are the most commonly affected areas.
- Breakthrough pain: This sudden and intense flare-up of pain can occur despite ongoing management efforts. It commonly occurs in cancer patients who suffer from recurring aches and pains, leading to health complications and poor quality of life. Managing breakthrough pain requires additional or alternative relief strategies to address the interrupted baseline pain control.
What Are the Causes of Cancer Pain?
Understanding the causes of cancer-related pain is critical for effective management. Pain can originate from various sources, including:
- Tumor growth: As a malignant tumor grows, it can invade and compress surrounding tissues, nerves, and bones, causing distressing pain. For example, severe bone and brain metastases are known to be painful and deadly.
- Infections and inflammation: Cancer patients are more vulnerable to infections due to a weakened immune system, which can trigger painful inflammatory responses. Specific bacterial pathogens are also responsible for cancer morbidity, treatment resistance, and mortality.
- Blockages: Tumors can cause painful blockages in internal organs or blood vessels. For example, a tumor obstructing the gastrointestinal tract may block the intestines and lead to intense abdominal pain, nausea, vomiting, and constipation. Similarly, tumors in the urinary tract can hinder urine flow, causing pain and potential kidney damage.
- Cancer treatments: Treatments like chemotherapy, radiation, and surgery can also cause pain. Chemotherapy-induced peripheral neuropathy, a condition where nerves become damaged due to intense chemotherapy drugs, is a common source of pain. Radiation therapy can cause tissue damage and inflammation, leading to pain. Post-surgical pain is another common issue, even in non-malignant conditions. Read on for a more detailed explanation.
How Does Cancer Treatment Cause Pain?
Depending on the treatments a patient receives, they can have different types of pain, including but not limited to:
- Post-surgical pain (e.g., mastectomy for breast cancer)
- Mucositis due to chemotherapy or targeted therapy
- Peripheral neuropathy due to chemotherapy or targeted therapy
- Spasms, stinging, and itching due to intravenous chemotherapy
- Bone pain (ostealgia) from pegfilgrastim or filgrastim, which are granulocyte colony-stimulating factors that help the body produce more white blood cells
- Pain in joints and muscles because of paclitaxel or aromatase inhibitor therapy
- Avascular necrosis from long-term use of anti-inflammatory drugs
- Osteonecrosis of the jaw (ONJ) as a result of bisphosphonates given for cancer that has metastasized or spread to the bone
- Radiation-induced pain syndromes, including:
How Does Cancer Pain Affect Quality of Life?
Unmanaged cancer pain impacts a patient’s physical, emotional, and psychological well-being. Physically, pain can lead to decreased mobility, fatigue, loss of appetite, and malnutrition, which can weaken the patient further. Emotionally, persistent pain can cause depression, anxiety, and helplessness. The psychological burden of pain can be overwhelming; it can make it difficult for patients to maintain a positive mindset and engage in daily activities.
What Do Doctors Consider Before Recommending Pain Treatment?
Recognizing that pain is a problem is the initial step in finding treatment. Patients must consult a healthcare professional about their symptoms to identify the source of pain and come up with a treatment plan that takes into account overall health and lifestyle.
The best possible treatment option will depend on the following:
- Medical history: Doctors begin by reviewing a cancer patient’s complete medical history, including chronic conditions (e.g., history of hypertension, diabetes, etc.), past surgeries, current medications and treatments, and general health. Evaluating a patient’s overall condition will help anticipate any adverse reactions between pain medications and other treatments.
- Assessment of pain characteristics: Understanding the nature and intensity of the pain will help identify the appropriate treatment approach. Doctors assess whether the pain is acute, chronic, breakthrough, or due to conditions like cancer-related arthritis. This step guides decisions on the type of pain relief interventions necessary, whether medications, physical therapy, or other modalities.
- Identification of underlying cause: Pinpointing the root cause of the pain is fundamental to tailoring treatment plans. Whether the pain stems from a surgical procedure, a cancer symptom, or a co-occurring chronic condition, oncologists must address the underlying cause to help the patient find relief. Different causes require specific approaches, such as targeted therapies like nerve blocks, or ongoing management with medications. This step ensures that treatments alleviate pain and target its source.
- Preferences and lifestyle: Doctors prioritize individual-focused care by involving patients in treatment decisions. Understanding preferences, lifestyle factors, and goals for pain management help doctors choose treatments that align with the patient’s values and enhance treatment adherence.
- Risk-benefit analysis: Before recommending any treatment, doctors conduct a thorough risk-benefit analysis. They weigh the benefits of pain relief against the risks of side effects and complications associated with each option. This critical evaluation ensures that treatment plans are safe and personalized to minimize adverse effects while maximizing pain management effectiveness. It also involves discussing with patients the risks involved in taking pain medications.
- Ongoing monitoring and adjustment: Pain management requires continuous monitoring and adjustment. Healthcare providers must regularly assess how a patient responds to treatment and monitor changes in their health. This iterative approach allows for prompt adjustments to treatment plans, ensuring that pain management remains responsive to the patient’s evolving needs.
Additional factors that can help determine which treatment is best:
- Location and scope of pain
- Specific type of pain (sharp, aching, burning, or tingling)
- Whether the pain comes and goes, or is constant
- What activities exacerbate the pain
- How the pain affects the patient (loss of appetite, reduced sleep quality, etc.)
- Severity
What Is the Pain Rating Scale?
A scale from 0 to 10 measures pain severity and decides which medication or approach to use.
- 0 is no pain
- 1 to 3 is mild pain
- 4 to 6 is moderate pain
- 7 to 10 is severe pain
What Are the Conventional Treatments for Cancer Pain?
For mild to moderate cancer pain:
- OTC pain relievers: Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can treat mild to moderate pain. While many are available over-the-counter (OTC), some may require a prescription. Patients must consult a doctor before taking any medication, particularly during chemotherapy, as NSAIDs can impact blood clotting, kidney function, and gastrointestinal health, and may heighten heart disease risks.
For moderate to severe cancer pain:
- Opioids: Also known as narcotics or opiates, these drugs encompass morphine, codeine, hydrocodone, buprenorphine, hydromorphone, fentanyl, oxycodone, and tramadol. They work by attaching to pain receptors and blocking the feeling. These potent medications are not accessible over the counter and require a prescription from a healthcare provider due to their controlled nature and potential for misuse.
For moderate to severe cancer pain with tingling, burning, and other agonizing sensations:
- Antidepressants: Some doctors prescribe antidepressants to alleviate pain, regardless of whether the patient is or is not suffering from depression. For example, a physician may prescribe an antidepressant called tricyclic to help relieve neuropathic pain or issues with the nerves. Amitriptyline, nortriptyline, and duloxetine are other examples of antidepressants sometimes prescribed to address pain.
- Anticonvulsants (anti-seizure medications): Gabapentin (Neurontin), pregabalin (Alzain, Lyrica), topiramate (Topamax), and lamotrigine (Lamictal) treat seizures and sometimes play a role in controlling burning and tingling sensations, which are painful symptoms of nerve damage in some cancer patients.
- Other drugs: Doctors may prescribe corticosteroids like prednisone to cancer patients to relieve pain caused by inflammation around tumors or due to cancer treatment. These medications help reduce swelling and pain intensity by inhibiting prostaglandin synthesis and decreasing vascular permeability. However, careful monitoring is crucial to manage potential side effects.
Patients need to take these medications at scheduled times to maintain a constant level of the drug in the body, which prevents the pain from coming back or worsening. Conventional drugs may be taken orally or given in other ways, such as by intravenous (IV) line or injection.
In hindsight, most people have questions and concerns about taking opioids or any other drug in general. Such queries, including “Will I become dependent on the drugs?” and “Will opioids shorten my life?” are best discussed with a specialist in chronic pain management.
What Are the Alternatives to Pain Medication?
As for patients who prefer not to rely on pharmaceutical drugs for pain management, alternative pain relievers are available. These methods focus on holistic and integrative approaches, aiming to address pain without the side effects associated with conventional medications. Alternative pain relief incorporates a range of practices, each tailored to the individual’s specific needs and pain sources.
A growing number of patients are also seeking alternatives due to concerns about the influence and practices of Big Pharma. Critics often accuse the pharmaceutical industry of prioritizing profit over patient well-being, linking it to issues like the over-prescription of painkillers and the opioid crisis. These concerns have increased skepticism about the safety and ethics of relying on prescription drugs for pain management.
Here at New Hope Medical Center, we have spent decades studying the science behind holistic healing, a form of care that considers the whole individual—body, mind, spirit, and emotions—in the pursuit of optimal health. The following pain management alternatives to opioids and Big Pharma drugs may help:
1. Relaxation techniques for cancer pain relief
These research-backed relaxation techniques may combat cancer pain:
- Breathing exercises: Proper breathing soothes the nervous system, reduces anxiety, and relieves stress, a.k.a. factors often heightened or in fight-or-flight among cancer patients. Deep or diaphragmatic breathing can bring a sense of calm by slowing the heart rate and lowering blood pressure. In a 2023 systematic review, pursed lip breathing revealed benefits for post-surgical pain, while slow deep breathing and Hey-Hu regular breathing were effective for pain management in children with cancer.
- Hypnotherapy: Hypnotherapy uses guided imagery and focused attention to achieve a state of deep relaxation. This method may alleviate pain and mitigate some of the side effects of cancer treatments, such as nausea from radiation therapy. In a 2022 review of 11 clinical controlled trials with 1,182 participants, the results showed that hypnosis significantly reduced both anxiety and pain compared to usual treatment.
- Massage: Gently manipulating the deeper layers of muscle and connective tissue can relieve pain, reduce stress, and promote relaxation in cancer patients. Massage therapy can also reduce anxiety, nausea, fatigue, and depression by 50%, according to a study published in the Journal of Pain and Symptom Management.
- Meditation: Meditation involves focusing the mind to achieve a state of calmness and heightened awareness. Regular meditation alters brain structure in ways that help manage pain. The resulting change in cortical thickness in some areas of the brain may make a person less pain-sensitive. Meditation may also stimulate the body’s opioid system.
- Yoga: This ancient Indian practice is a diverse collection of techniques that control the mind, recognize a detached witness consciousness, and transform the body. Some patients say it helps ease their minds and help them cope better with their cancer. Others say it helps reduce symptoms and side effects like pain, sleep problems, tiredness, and depression.
- Tai Chi: This ancient form of non-combative martial arts involves graceful, flowing movements that support balance, flexibility, muscle strength, coordination, and stamina. Results from clinical trials suggest that the practice decreases pain; improves flexibility, balance, mobility, and strength; and lowers the risk of falls.
2. Herbs and essential oils
People have used herbs and essential oils as natural pain relievers for centuries. Although scientists have not fully explored the abundant healing alternatives nature has to offer, some evidence suggests that the following may alleviate pain:
- Lavender
- Rosemary
- Peppermint
- Eucalyptus
- Ginger
- Turmeric
- Feverfew
Refer to this article for a comprehensive guide to the above alternatives to ibuprofen and other painkillers.
3. Transcutaneous electrical nerve stimulation (TENS)
A TENS unit employs low-voltage electrical currents to relieve pain. In cancer treatment, TENS is applied to specific areas of discomfort, where it may block pain signals to the brain and prompt the release of endorphins. There is no consensus on the efficacy of TENS, but careful use shows positive outcomes.
4. Acupuncture
Acupuncture is an age-old Chinese integrative medicine technique. It involves inserting very thin needles into specific points on the body to manage pain and promote healing. For people with cancer, this technique may reduce pain and treatment-related side effects. It works by releasing endorphins, the human body’s natural pain-relieving chemicals, and by stimulating the part of the brain that modulates serotonin, a chemical involved with mood. However, the small sample sizes of existing evidence limit the claims’ strength and highlight the need for additional research.
Cancer Pain Control Can Improve Your Quality of Life
Cancer pain can be twice as excruciating if the person is depressed and/or anxious. Sadly, most patients have trouble talking about their pain.
If you’re suffering, you must tell your cancer care team about it immediately. Describe the pain in the best way you can. Remember, pain from cancer can consume you, weaken you, and prevent you from doing the things you love and need to accomplish. Fortunately, there are more ways than ever to address pain, allowing you to continue many of your favorite activities.
A comprehensive pain management plan tailored to your needs can help alleviate pain, enhance mobility, improve sleep, and allow you to participate more fully in your daily life. Call New Hope Unlimited at 480-666-1403 or write to us to schedule a consultation, discover ways to manage cancer pain, and improve your quality of life.
