As well as painkillers, there are other ways to help control cancer pain. These include cancer treatments to shrink your cancer. Other ways include injections, nerve blocks and acupuncture.
Palliative treatment is treatment that aims to reduce or stop symptoms rather than cure your cancer. You might have some side effects from palliative cancer treatments. But the aim is to make you feel better. So your cancer specialist will try to choose treatments that have as few side effects as possible.
There are also many ways that you and your family can help to control your pain.
Cancer treatments can help to reduce pain by shrinking a tumour and reducing pressure on nerves or surrounding tissues. After cancer treatments, you might be able to cut down on your painkillers. But it can take several weeks before you get the full benefits of the treatments. So you’ll need to carry on taking your painkillers in the meantime.
Treatmens that can help include:
- chemotherapy or biological therapies, which can shrink many types of cancer to reduce symptoms such as pain.
- hormone treatments, which can shrink some types of advanced cancer such as breast, prostate, womb and kidney cancer.
- radiotherapy, which can give very good long lasting pain control for certain types of cancer pain such as bone pain
- radiofrequency ablation (RFA), which uses heat made by radio waves to kill cancer cells
In some situations, doctors can use surgery to control pain. A surgeon might carry out an operation to take away as much of a tumour as possible.
This is called debulking. It can relieve pain by relieving pressure. It may also prevent complications developing, such as a blocked bowel.
This might be called an epidural, intrathecal anaesthetic or spinal anaesthetic. It can give very good pain control.
To give painkillers in this way, doctors put a small tube (called a catheter) is put into your back. It goes into the area around the spinal cord. The painkiller is continuously injected through the tube into your spine.
This may be the best way to control your pain if you’re having a big operation for your cancer. It will give good pain control for up to 24 hours after your surgery.
This method is not a first choice for treating cancer pain that’s not related to surgery. But it can help some people who find that painkilling tablets or injections are not controlling their pain.
It needs a highly experienced doctor (anaesthetist) to do the procedure. It also needs highly trained nurses to watch you very closely afterwards. Not all hospitals, hospices or pain clinics can provide this service.
Sometimes a small pump is put into the fluid around the spinal cord. It’s called an implanted intrathecal pump and it goes in your back area just below the waist. You can stay at home with the pump. A cancer specialist can inject painkillers into the pump every few weeks.
Doctors usually use this type of treatment where other methods of pain control have not worked.
Your doctor might suggest a nerve block if you have pain that is difficult to treat. This is a way of killing or deadening a nerve to stop it causing pain.
There are not usually many side effects to nerve blocks. You might have low blood pressure afterwards. The low blood pressure can make you feel light headed if you stand up too quickly. But this usually gets better over a few days.
There are different types of nerve block. Their names are to do with the nerves they treat.
Coeliac nerve block
The coeliac plexus (pronounced seel-ee-ak pleck-sus) is a complicated web of nerves at the back of the abdomen. It can cause ongoing pain in people with pancreatic cancer and some other types of cancer.
To block the pain you can either have:
- an injection into the nerve
- a small operation to cut the nerve
For a nerve block using an injection, the doctor injects either local anaesthetic (with or without steroids), or alcohol into the coeliac plexus. Alcohol gives a longer lasting block. You’ll probably have medicine to make you drowsy (sedation) before this procedure.
First, you have a small injection of local anaesthetic to numb your skin. The doctor then puts a long needle in through your back or chest to the coeliac plexus. During the procedure you have X-rays or CT scans so your doctor can check the needle is in exactly the right place.
In some cases, you may have the needle put into the coeliac plexus through the stomach wall during an endoscopy.
Some research has shown that up to 9 out of 10 people with abdominal cancers can get short and long term pain relief with a coeliac nerve block.
Up to 6 out of 10 people have diarrhoea after this treatment, but this usually gets better within a couple of days. A very small number of people have severe, ongoing diarrhoea afterwards.
Your doctor might think it is better to cut the nerves causing the pain, instead of just injecting them. This is a small operation and you may have it done during other surgery, such as bypass surgery.
Again, you might have sedation first. You then have a local anaesthetic and the anaesthetist pushes a thin needle into the nerve. The needle has a laser or radiofrequency probe at the tip, which cuts the nerve. The anaesthetist may use ultrasound or a CT scan during the procedure, to make sure the needle is in the right place.
Another type of nerve block is called thoracoscopic sympathectomy. This means the doctor uses a thoracoscope to reach the nerves in the chest. This is a tube with a camera, eyepiece and light that enables the surgeon to look inside the body.
You have either a general anaesthetic or a sedative. You have a few small cuts (incisions) made between your neck and breastbone. The surgeon uses the thoracoscope to look inside and find nerves that are part of a chain called the sympathetic nerve chain.
The surgeon then uses a laser or radiofrequency probe at the tip of the thorascope to block this chain of nerves.
Cutting the splanchnic nerve
The splanchnic nerves send signals from the spinal cord to the organs in the chest and abdomen. Pressure on the splanchnic nerves can cause continuing pain in some types of cancer.
Cutting the splanchnic nerve is called splanchnicectomy (pronounced splank-nik-ectomy). It can reduce pain for many people.
Cancer that spreads to the bones often causes pain. Cancer in the bones can make them weak and more likely to break. This type of break is called a pathological fracture.
Doctors can treat bones affected by cancer by using special cement to strengthen them. There are two techniques:
vertebroplasty and kyphoplasty
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.
Doctors use the cement to fill parts of bone destroyed by cancer that are causing pain. It can help to relieve pain and make the bone more stable. It has also improved walking for some people.
You have this minor operation either under a general anaesthetic. Or when you are drowsy after taking a sedative. Using X-rays to guide the way, the doctor puts a needle into the skin and injects the cement into the bone.
You are most likely to have percutaneous cementoplasty to help control symptoms of secondary bone cancer. You are less likely to have this treatment for a cancer that started in the bone (primary bone cancer).
The National Institute for Health and Care Excellence (NICE) guidance says that doctors can use percutaneous cementoplasty as part of NHS treatment, but only if other ways of treating your pain have not worked.
Vertebroplasty and kyphoplasty
These are forms of cementoplasty.
In vertebroplasty, bone cement is injected into damaged bones in the spine (vertebrae). The treatment eases pain and helps to support the spine. Some studies have shown that vertebroplasty can relieve pain in around 8 out of 10 people (80%) with myeloma or other types of cancer that have spread (metastatic cancers).
Balloon kyphoplasty is similar to vertebroplasty. It treats fractures of 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. Then special cement is injected into the space created by the balloon to strengthen the bone. Trials have shown that this technique can help to relieve pain and restore some height.
NICE has issued guidance on vertebroplasty for treating fractures in people with painful conditions of the spine, including tumours. They say that doctors should consider it only if other ways of treating your pain haven't worked.
NICE has approved balloon kyphoplasty for use in the NHS as a treatment for collapsed bones in the spine.
TENS stands for transcutaneous electrical nerve stimulation.
TENS may temporarily help pain that is in one area of the body. But more studies are needed in people with cancer pain to know this for sure.
Your doctor or nurse will stick small pads onto your skin, which release a small electrical charge. This causes a tingling feeling in the skin. By stimulating the nerves that run up the spine to the brain, TENS blocks the nerves carrying the pain messages.
TENS may be worth a try because it’s easy to use and has few side effects. You can ask your doctor or specialist nurse if it could help your type of pain.
There is not yet enough evidence to show for sure that acupuncture can relieve cancer pain.
But some research studies have shown that acupuncture can reduce muscle pain or bone pain for some people. It makes the body release pain relieving chemicals. It seems to work very well when cancer pain is causing muscle spasms that make the pain worse.
There are many ways that you and your family can help to control your pain.
You may have noticed that your pain seems worse if you’re anxious or worried. It often seems worse at night if you can’t sleep and there’s nothing else to distract you.
Here are some things to try that can help relieve your pain.
- Change your position at least every two hours to prevent stiffness and sore skin.
- Hot or cold packs can help relieve pain, but wrap them in a soft towel so they don't damage your skin.
- Watching TV, reading or chatting can help to take your mind off your aches and pains.
- Relaxation – use tapes or listen to some calming music and think of somewhere beautiful you'd like to be.
- Breathing – try to breathe slowly and deeply when you are tense.
- Massage – ask your family or friends to give gentle massage to your back, hands or feet, or treat yourself to a professional massage.
- Aromatherapy, hypnotherapy, acupuncture and reflexology are all types of complementary therapies which may help.
- Talking to someone about your pain - perhaps a counsellor - can help to relieve stress and tension and make it easier to cope.
These things might help you to take some control over your pain and make it seem better for a time. Learning relaxation exercises can be very helpful if you can’t sleep.
Remember not to get too tired. Visitors are a wonderful distraction, but when you’re not well it’s often better to see people just for short periods.