Battling Cancer and Pain
Fighting chronic pain which can be mild, moderate or severe on a daily basis, is part of the cancer struggle, which may be present for years to come
Due to the treatment, many cancer patients and survivors experience pain. This pain may be continuous, intermittent or breakthrough pain and often subsides when the treatment ends. It is called acute pain which is similar to the pain experienced after an operation.
Thus, the torment cancer patients face, doesn’t stop even after the treatment has been discontinued. Battling chronic pain which can be mild, moderate or severe on a daily basis is a part of their struggle, which may be present for years to come.
Pain After Surgery
Soon after the surgery, patients may experience mild, moderate or excruciating pain along the operative site depending on the site and kind of surgery. Hence, most cancer centres today have a specialized Pain Clinic or Acute Pain Service.
Treatment is planned and delivered orally or intravenously to treat the pain, minimize side effects and enhance the quality of recovery. Treatment may also be multimodal and can involve physical therapy, nerve blocks, epidural drugs, and nerve stimulation. Acute pain needs to be addressed aggressively and a quick look at some hypothetical case studies will provide a better insight into the plight of various cancer patients.
Hypothetical Case Studies
Ram Bahadur is 75 years old and has smoked for most of these years. He underwent a major surgery of the large intestine. The scar runs from his lower rib cage to below his navel. The Acute pain team placed an epidural catheter before surgery to target the expected pain.
When he woke up from the anesthetic he had no pain and could breathe deeply. If pain impairs the ability to breathe deeply, after an abdominal surgery, patients, especially elders can land up with pneumonias and a complicated and expensive ICU stay.
Sunita Arora was treated for breast cancer five years back. She had her breast removed (mastectomy) and underwent chemotherapy and radiotherapy after the surgery. She remembers mild discomfort for about three days after the surgery, in her chest and upper arm and armpit. But she has more vivid memories of the burning pain in the mouth and painful meals during chemotherapy.
For Sunita, the chemotherapy-related mouth pain (mucositis pain) was a bigger issue. It is imperative to treat this, because she couldn’t eat due to the painful mouth ulcers. This impacted her quality of life and poor nutrition also affects the ability to tolerate further chemotherapy.
An agonizing ‘pain’ that Sunita didn’t immediately complain about was the loss of self-esteem. She had an altered body image due the removal of the breast and perceived herself as unattractive and incomplete. Supportive care teams have multidisciplinary input and with the help of psychological support, group therapy, pain medications and a semi-solid diet she recovered her appetite, weight and her ‘whole’ self.
Cancer and its treatment can occasionally also damage the nerves. Riyaz complains of a burning pain and a strange numbness in the soles of his feet and palms of his hands. This started two months after he received chemotherapy. The hands and feet feel heavy and cannot sense hot or cold. Appropriate nerve pain medications like anticonvulsants, antidepressants decreased the pain and improved the quality of sleep and the quality of life.
But, Riyaz will always need to protect his hands and feet from injury, not walk bare feet, avoid contact with hot water and avoid movements that require rapid motion for instance, rapidly chopping using a knife. This is difficult for him because he is a chef. However, he has gradually come to terms with this, because he is better oft than many other cancer patients – he is cured!
Pain Due To Relapse
Some patients may have chronic pain because the cancer has recurred or spread. So for ease of assessment, monitoring, and treatment, pain is measured in numbers usually on a scale from zero to ten. The good news is that relief from severe excruciating pain is possible for more than eighty per cent patients through oral inexpensive tablets called morphine.
A Tragic Scenario
But here’s the bad news. These strong painkillers (morphine) are available to less than four per cent of the people who need them in India. Government policies, legislation, lack of awareness and education have all contributed to this state of affairs. So the tragedy is that we grow it in our state and ‘make it in India’ but we sell it to the developed world. Also, very few doctors have the training to use morphine and only a tiny number of patients have access to it.