PAIN MANAGEMENT IN CANCER

1. PAIN MANAGEMENT IN
CANCER
SUDESHNA BANERJEE
M.SC 1ST YEAR
HFCON

2. PAIN
An unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage.

3. CLASSIFICATION OF PAIN
ACCORDING TO SPECIFIC CHARACTERISTICS:
Region of the body involved
Duration and pattern of occurrence
 Intensity and onset
 Etiology

4. ACCORDING TO ETIOLOGY OF PAIN:
NOCICEPTIVE:
• Nociceptive pain is caused by stimulation of sensory
nerve fibers that respond to stimuli approaching or
exceeding harmful intensity
E.G: thermal, mechanical, chemical
 Nociceptive pain may also be divided into “visceral”,
“deep somatic” and “superficial somatic” pain

5. • Visceral structures are highly sensitive to stretch,
ischemia and inflammation. Visceral pain is diffuse,
difficult to locate
• Deep somatic pain is initiated by stimulation of
nociceptors in ligaments, tendons, bones, blood
vessels, fascia and muscles, and is dull, aching,
poorly-localized pain

6. • Superficial pain is initiated by activation of
nociceptors in the skin or other superficial tissue,
and is sharp, well-defined and clearly located
E.g: Minor wounds, first degree burns

7. NEUROPATHIC:
• Neuropathic pain is caused by damage or disease
affecting any part of the nervous system involved in
bodily feelings
• Peripheral neuropathic pain is often described as
“burning”, “tingling”, “electrical”, “stabbing”, or
“pins and needles”
• E.g: diabetic neuropathy

8. PHANTOM:
Phantom pain is pain felt in a part of the body that
has been lost or from which the brain no longer
receives signals. It is a type of neuropathic pain
Phantom limb pain is a common experience of
amputees

9. PSYCHOGENIC:
Psychogenic pain, also called psychalgia; is pain
caused, increased, or prolonged by mental,
emotional, or behavioral factors
E.G: Headache, back pain, and stomach pain

10. BREAKTHROUGH PAIN:
Breakthrough pain is acute pain that comes on
suddenly and is not alleviated by the patient’s
normal pain management
It is common in cancer patients who often have
background pain that is generally well-controlled by
medications, but who also sometimes experience
severe pain that from time to time “breaks
through” the medication

11. INCIDENT PAIN:
Incident pain is pain that arises as a result of activity,
such as movement of an arthritic joint, stretching a
wound, etc
REFERRED PAIN:
Pain occurring in a visceral structure is usually not felt
in the viscous itself but on the surface of the body or
in some other somatic structure that may be located
quite some distance away

12. ACCORDING TO SEVERITY:
ACUTE PAIN –: usually of recent onset and
commonly associated with specific injury; lasting
from seconds to 6 months
CHRONIC PAIN : constant or intermittent pain
that persists beyond the expected healing time to
a specific cause or injury; lasts for 6 months or
longer

13. ACCORDING TO INTENSITY:
 Mild pain- rating of 1-3
 Moderate pain- rating of 4-6
 Severe pain- reaching 7-10 and is associated
with worst outcome.

15. PATHOPHYSIOLOGY OF PAIN

16. WHO PAIN LADDER

18. MANAGEMENT
Anticancer interventions
RADIATION:
• Relieves pain by killing cell to reduce tumor size
• Promotes re-mineralisation of bone
• Usually delivered as external beam treatment or
systemic radioisotopes

19. • Radiation therapy is the use of X-rays to
destroy cancer cells and shrink tumors
• Radiation damages the genetic material of cells in the area
being treated, leaving the cells unable to continue to grow
• Although radiation damages normal cells as well as cancer
cells, the normal cells can repair themselves. The cancer
cells cannot

20. CHEMOTHERAPY:
Kill cells, reduce tumor size and reduce
tumor compression on nerves
Not suitable in tumors which are not chemo
sensitive
It can induce pain in itself

21. HORMONE THERAPY:
Used in mostly breast and prostate cancers
useful for patients with widespread disease
and metastatic pain
Anti estrogen and anti androgen drugs are
used respectively

22. BIPHOSPHONATES:
Slows down the rate of growth of bone crystals and
their dissolution
Used in the management of cancer-induced bone
pain(CIBP)
Reduce morbidity from bone metastasis by reducing
skeletal events and preventing the need for
radiotherapy

23. DRUG THERAPY
 NSAIDS
 Narcotics
 Anti-depressants
 Anti-convulsants
 Corticosteroids

24. RADIOFREQUENCY ABLATION (RFA):
Uses heat made by radio waves to kill cancer cells.
The electrical energy heats up the tumor and kills the
cancer cells.

25. EPIDURAL /INTRATHECAL/SPINAL
ANAESTHESIA:
The painkiller is continuously injected through a
small tube (catheter) into spine. If having a big
operation for cancer this may be the best way to
control pain
Sometimes a small pump is put into the fluid
around the spinal cord. It is in back area just below
the waist. It is called an implanted intrathecal pump

26. NERVE BLOCKS:
• This is a way of killing a nerve to stop it causing pain.
There are not usually many side effects to nerve blocks
• Pressure on the splanchnic nerves can cause continuing
pain in some types of cancer.
• The splanchnic nerves send signals from the spinal cord
to the organs in the chest and abdomen. Cutting the
splanchnic nerve is called splanchnicectomy. It can
reduce pain for many people

27. STRENGTHENING PAINFUL
BONES
PERCUTANEOUS CEMENTOPLASTY
• Cementoplasty means using a special cement to
strengthen and support bone.
• Percutaneous means under the skin, and describes how
the cement is put into the bone.
• It can help to relieve pain and make the bone more
stable. It has also improved walking for some people

28. VERTEBROPLASTY AND
KYPHOPLASTY
• Bone cement is injected into damaged bones in the
spine (vertebrae). The treatment eases pain and
helps to support the spine
• For kyphoplasty, little balloons are put into the
spine. They are slowly inflated so that the spine
goes back to as near its normal height as possible

30. KYPHOPLASTY

31. COMPLEMENTARY THERAPY
FOR CANCER PAIN
ACUPUNCTURE:
Insertion of needles into the skin and underlying tissues for
therapeutic or preventive purposes at specific sites, known as
acupuncture points
AROMATHERAPY:
This is the controlled use of plant essences, applied either to the skin
through massage, added to baths or inhaled with steaming water

32. HYPNOTHERAPY:
This is the induction of a trance-like state to
facilitate relaxation and enhance suggestibility for
treating conditions and introduce behavioural
changes
MASSAGE:
This is the manipulation of the bodies soft tissue
using various manual techniques and the
application of pressure and traction

33. NURSING DIAGNOSIS
 Acute pain related to disease condition
as evidenced by pain scoring
 Anxiety related to present situation as
evidenced by patient is frequently asking
questions

34. Anticipatory grieving
Ineffective coping
Risk for infection