The article was published under the same heading in the health section of Times of India, dated 15.02.2014.
For all the happiness mankind can gain; is not in pleasure, but in rest from pain. John Dryden
World Cancer Day had just passed us by – another day in the calendar for most of us – the significance of which is lost in our busy daily lives. For the millions who suffer from cancer, the day is a reminder of a disease which is consuming them slowly but surely. The physical and emotional pain of the disease adds to their feeling that the entire world, along with their loved ones, is slipping slowly away, as they watch helplessly. It is only humane for us to stand up to help our fellow beings in pain. It is vital that we turn inwards to find solutions for the sufferer’s predicament; therefore, empathy goes a long way. So does advances in science and evolving technology, which has put us in a better position to treat and manage cancer especially when it is detected early. What has also progressed significantly, to alleviate the pain of cancer, is the speciality of Pain Medicine.
More than a bodily burden
Excruciating pain is a significant challenge with cancer, especially in individuals who are at the end stages of their life. This pain is a result of erosion and destruction of the tissues, nerves and bones. The pain affects not just the patient, but also his or her family and friends. The emotional and the psychological burden make the pain worse, which in turn inflicts a powerful blow to the psyche of the sufferer. This only gets steadily and progressively terrible as the disease advances. A mother might tolerate the pain of labour and the religious might bear the pain of self-inflicted wounds in the hope of a superior joy, whereas in cancer it is a war in the body as well as in the mind. Quite often a losing war, it adds greatly to the socioeconomic burden.
So, the question then is ‘what could be done to relieve the pain?’
Could we manage cancer pain effectively?
The answer is a resounding Yes!
Relieving pain in cancer is a team effort. The team has the principal physician, the surgical / medical oncologist and the pain specialist. This is in addition to the nurses, social workers and other allied-health personnel. The success of the endeavour relies on the co-ordinated effort of the team, which works closely with the patient as well as his family. The oncologist plays the primary role with treating and controlling the disease process. This helps relieve a large part of the pain. The pain specialist contributes by titrating and adjusting the dose of pain medication or by performing an interventional pain procedure which could help relieve the suffering.
The reward of a well planned out interventional procedure is not just the reduction in intensity of the pain, but also the dramatic decrease in the need for opioid medications. One such procedure – which is very effective and ought to be done more in India – is coeliac plexus block for cancer of the pancreas. In this, the sympathetic nerves which carry the pain sensation from the diseased pancreas are blocked either by chemicals or by radiofrequency ablation. Certain other procedures such as the intercostal block could be performed for lung and chest wall cancers. Epidural space is a small potential space which surrounds the spinal cord. Infusing pain killers through specially implanted ports into the epidural space could provide pain relief for longer periods. On other occasions, for different indications, a catheter could be inserted into the bag of fluid surrounding the spinal cord, and small doses of pain killers could be trickled continuously to relieve pain by modifying the pain pathways.
Managing cancer pain is a multi-disciplinary endeavour, which in order to be successful requires a concerted team effort. Cancer pain, for sure, is an insult on an already wounded individual. A pain physician, who is part of the core team which considers relief of cancer pain as its foremost goal, could perhaps be the sufferer’s best friend.
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