Cancer Pain Management

Pain in cancer patients may arise due to many reasons. It may be:

• related to cancer itself. Pain is often the presenting complaint leading to the diagnosis of cancer.
• due to local spread of the disease, destruction to the adjacent structures or from distant spread (metastases) from the disease.
• a later presentation due to side effects of various tests and treatments undertaken for chemotherapy, radiotherapy or surgery.
• a result of extra stress placed on other body parts such as shoulder pain due to using a stick for walking.
• due to neuropathic pain which can occur if nerves are affected by cancer.
• totally unrelated coincidental problems such as arthritis.
• ‘Phantom Pain’ which occurs from the surgically removed diseased part.

• Neuropathic/Nerve pain: This is a burning, shooting, electric shock-like or stabbing pain with associated tingling or numbness.
• Visceral pain: It originates from viscera (organs in body cavity) and is generally described as a deep aching, squeezing and cramping sensation.
• Bone pain: This is an aching, throbbing sensation, increasing with particular movements or weight bearing.

Max Institute of Cancer Care offers integrated Pain & Palliative Care management services for a wide variety of conditions, including cancer pain, palliative care issues, supporting patients undergoing disease directed treatments & also during end of life care. Our expert pain & palliative consultants assess the patient in a holistic way and also guide them to reachout to physiotherapists, psychologists, occupational therapists, dieticians and Ayurveda & wellness specialists, to work together as a team to maximize your health gains. We do provide non-surgical alternatives using a multidisciplinary approach and coordinated care customized to suit individual needs.

Our experienced team will give you complete guidance, advice and support in implementing lifestyle modifications to help sustain the benefits. We work with you not only to reduce the pain but also the impact of pain on your life.

Max Healthcare’s cancer pain management and support services include:

• Managing physical problems: management of pain, breathlessness, non-healing ulcers, oral ulcers, nausea, vomiting and other distressing symptoms in patients undergoing disease directed treatment.
• Managing psychosocial problems: Like depression, anger or denial in response to the illness, emotional isolation etc.
• Managing spiritual pain and integrating the psychological and spiritual aspects of patient care.
• Offering a support system to help patients live as actively as possible.
• Providing terminally ill patients with end of life care.
• Offering a support system to help the family cope during the patient's illness and in their own bereavement.

Cancer patients must receive adequate pain relief as it helps them eat, sleep and remain active during the day time and allows them to enjoy time with family and friends. This prevents them from falling into depression and helps adhere to the treatment as advised.

Accordingly, cancer pain relief at Max Institute of Cancer Care is individually tailored depending on the cause, severity and duration of the pain. In most cases, reasonable control is achieved by using a combination of methods. Our multimodal, multidisciplinary approach provides the opportunity to maximise pain relief. Besides physical symptoms like pain, nausea, vomiting, fatigue, our palliative care team will also support you and your family for emotional, social and spiritual needs.

Additionally, patients can choose from the following types of palliative care services:

• Outpatient basis: You may come to the front desk and ask for a Palliative Care Physician for consultation.
• Virtual consultation : Max healthcare has a virtual consultation platform, My healthcare plus application, which can be used to consult our pain & palliative care specialists from the comfort of your home.
• Inpatient services: You may require admission into the hospital for appropriate management of your condition.
• Home care: Liasioning with the home care teams to guide them for supportive care at home.

• Available on request: Patients and their families can request for specialized palliative care services at any time during a severe illness.
• Patients can be referred: Physicians and medical staff at hospitals or other healthcare facilities will refer a patient or request that the hospitalized patients be evaluated for services by the hospital's palliative care team.

The various options offered by Max Institute of Cancer Care for cancer pain management are:

A) Medications Management: This involves using different classes of medications to optimize pain control. A combination of drugs helps minimize side effects and maximize the benefits.

The drugs that are used to cancer pain management are called analgesics and broadly classified as follows:

• Non-opioids/Non-Steroidal Anti-Inflammatory Agents: These are a class of drugs used to control mild to moderate pain and inflammation.
• Opioids: Also known as narcotics, opioids can only be procured with a duly prescribed form by a registered medical practitioner. They are used for the management of moderate to severe cancer pain. Opioids are the mainstay of cancer pain management worldwide.
• Adjuvants: Include antidepressants, anticonvulsants and steroids. They are used along with non-opioids and opioids to manage cancer pain. Antidepressants and anticonvulsant drugs are used to manage tingling and burning pain due to involvement of nerves. Steroids help whenever there is swelling involved with pain.

• Nerve blocks – Majority of nerves can be targeted safely e.g. Pudendal Nerve for perineal or rectal pain, Suprascapular Nerve for shoulder pain, Pectoral Nerve for chest wall pain.
• Neurolytic procedures - These include Celiac Plexus, Splanchnic Nerves, Hypogastric Plexus, Lumbar Sympathetic, Ganglion Impar, etc.
• Radiofrequency procedures - Here conventional/ pulsed radiofrequency waves are used for neurolysis.
• Drug infusions- For breaking pain cycle, titrating opioids & decreasing central & peripheral sensitization.
• Spinal and joint injections - For patients with cancer presenting with chronic back pain & joint pains.

• What is Breakthrough Cancer Pain?
• What does a Pain Clinic Do?
• Symptoms of most common cancers among women
• Most common cancers among men and its symptoms
• Know About the Common Cancer Myths and Misconceptions
• Why Live with Pain? It can be cured!