Cancer pain is often multifactorial (arising from many separate mechanisms) and can involve elements of tissue pain (nociceptive pain), neuropathic pain, visceral pain, inflammatory pain, bone pain, ischaemic pain (pain from poor blood supply), and even burn pain.

While cancer pain is usually managed by general practitioners, oncologists, haematologists, and palliative care physicians, often a referral to a pain medicine specialist is required. This may be when there are unacceptable side effects from medications, the usual medications are not effective enough (or stop working), or when advanced techniques and procedures are being considered.

Cancer treatment is becoming more successful and many cancer sufferers are living for years or even decades longer than they would have in the past. Survivors and those still receiving curative or palliative treatment frequently experience ongoing pain and suffering, sometimes as a consequence of the cancer itself and often-times as a result of the cancer treatment. This includes but is not limited to: chemotherapy induced peripheral neuropathy, pathological fractures, radiation mucositis, nerve root compression, chronic post-surgical pain, and medication associated side effects like lethargy, impaired cognition, nausea or loss of appetite.

 

Management

While cancer pain is frequently difficult to treat, there have been major advancement in recent years. This includes the introduction of new technology, new medicine and new ways to use old drugs. New technologies such as Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation have both shown incredible response rates. QPain’s specialists are considered experts in this new technology.

QPain’s specialists will work with you and your other doctors to create a personalised treatment program specifically for you.

Cancer pain treatment may include:

  • Non-procedural treatments:
    • Pharmacotherapy (medications)
      • Antineuropathic medications:
        • Anticonvulsants: pregabalin (Lyrica), gabapentin (Neurontin), carbamazepine (Tegretol)
        • Antidepressant medications: amitryptylline (Endep), nortryptylline (Allegron), duloxetine (Cymbalta), venlafaxine (Efexor), desvenlafaxine (Pristiq)
      • Opioids and related drugs: tapentadol (Palexia), oxycodone (Endone, Targin, Oxycontin), buprenorphine (Norspan, Temgesic), fentanyl (Durogesic)
      • Anti-emetics / anti-nausea medications: metoclopramide (Maxolon), 5HT-3 antagonists (Ondansetron, Tropisetron)
      • Others: botulinum toxin, local anaesthetics (lignocaine), pamidronate, ketamine, corticosteroids (Dexamethasone, Cortisone, Prednisone)
    • Psychological and physical therapy
  • Procedural treatments:

Multimodal or multidisciplinary treatments are often considered to be the best approach. QPain also offers pain management programs, which aim to improve the quality of life and function for those with cancer pain.