Pain is the body’s way of indicating to the brain that something is wrong. Pain may be acute or chronic. Acute pain is usually short-lived, may be the result of an injury and subsides when the injury heals. Chronic pain occurs over a long period of time and ranges from mild to severe. 

It is essential that patients who have cancer receive aggressive pain management. Chronic pain may interfere with healing, result in anxiety and depression, disrupt sleep and curb the appetite, weakening the body’s immune defenses. 

Patients can help their doctor assess pain by clearly communicating what the pain feels like and by keeping a pain log. The severity of the pain will guide the appropriate treatment, typically with an analgesic, a medication that relieves pain. Most doctors use the Three-Step Analgesic Ladder approach developed by the World Health Organization (WHO). 

The WHO Three-Step Analgesic Ladder

A pyramid illustrating the three steps on the analgesic ladder.

Medications for Pain

Pain medications may be given in various ways. Most are taken orally with good results. Other ways of giving pain medications are: subcutaneously (injection under the skin); through the skin using a transdermal patch; rectally, by the use of a suppository; intravenously (injected into a vein); or intrathecally (injected into the spinal canal).

Another method of delivering pain medication is patient-controlled analgesia (PCA). In PCA, the patient controls the amount of medication delivered by a computerized pump programmed for a maximum dosage. PCA is commonly used after pancreatic cancer surgery in the immediate postoperative period.

Adjuvant drugs, which treat a variety of problems in addition to pain, are also commonly used to enhance the effectiveness of pain medications. Some provide pain relief by themselves. Typical adjuvant drugs include corticosteroids, anticonvulsants, tricyclic antidepressants and antianxiety medications.

Additional Ways to Treat Pain

There are also nondrug therapies that may be useful to help manage cancer pain. Doctors may suggest the use of heat, cold or physical therapies. Massage, hypnosis, acupuncture and emotional support groups and individual counseling may also be effective. 

For pain that does not respond to other measures, a nerve block may be performed. A local anesthetic or an alcohol solution is injected into the nerve root of the celiac plexus using ultrasound or computed tomography guidance. The effects last up to three to four months. Sometimes a skilled surgeon will perform a neuroablation, in which part of the pain nerve fibers are cut or destroyed. Radiation therapy also can be used effectively to relieve pain by shrinking tumors.

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