There are many different ways of controlling pain if you have advanced gallbladder cancer.
The pain may be in other parts of the body if the cancer has spread. This could be the spine or abdomen. The main way of controlling pain is using painkillers.
Pain can usually be very well controlled. It should be possible for you to be pain free at least when you are resting, if not all the time. The most important thing with any painkiller is to take it regularly.
If your pain relief isn’t working, or you are getting pain before the next dose tell your doctor or nurse. They can work out if you need different painkillers or to increase the dose.
If your treatment team can't control your pain you can ask them to refer you to a pain control team or symptom control team.
There are many different painkillers. Some are available over the counter from your chemist, such as paracetamol. These drugs can be very useful for mild pain, but they don’t control more severe pain. Talk to your doctor or specialist nurse if you’ve been taking a mild painkiller and you are still in pain.
You might need to have a stronger painkiller such as codeine or dihydrocodeine (DF118), perhaps with an anti inflammatory drug, such as ibuprofen (Nurofen) or diclofenac (Voltarol).
If the pain is still not controlled you might need a stronger morphine-type painkiller.
You might need a strong painkiller, such as morphine. It is a strong opioid and a very effective painkiller. There are other types of strong painkiller.
When you have them in the right doses and at the right times, they can control pain well. They might cause side effects at first but these usually wear off after a day or so.
You can have strong painkillers in different ways, such as:
- a liquid or tablet every 2 to 4 hours
- slow release tablets, taken every 12 hours
- through a drip
- through a pump connected to a small needle under the skin
- as suppositories
- skin patches
Controlling side effects
Most strong painkillers have side effects. They cause constipation and so it helps to start taking regular stool softeners or laxatives as soon as you begin regular painkillers. Ask your nurse or doctor to prescribe them.
You might feel dizzy, light headed and drowsy but this usually wears off after a couple of days.
Painkillers sometimes make you feel sick at first so you might have anti sickness medicines for the first week or so.
Chemotherapy or radiotherapy to control pain - gallbladder
Cancer treatments such as chemotherapy and radiotherapy can help to control pain. They can shrink a tumour that is pressing on a nerve or another organ and causing pain. You might be able to cut down on your painkillers after having treatment.
Nerve blocks are a way to treat difficult pain. This is a way of killing or numbing a nerve to stop you feeling pain in that area of the body. There are different types of nerve block, named after the nerves that are treated.
Coeliac plexus nerve block
The coeliac plexus is a complicated network of nerves at the back of the tummy (abdomen). Gallbladder cancer can put pressure on the coeliac plexus and cause ongoing pain.
A coeliac plexus nerve block is when alcohol is injected into the coeliac plexus to kill off the nerves and control the pain. You have a CT scan so your doctor puts the needle into the right place. A local anaesthetic numbs your skin, then the needle goes in through your back to the coeliac plexus. Sometimes this is done using endoscopic ultrasound to guide the needle to the right place.
Splanchnic nerve block
The splanchnic nerve can cause continuing pain in pancreatic or gallbladder cancer. It goes from the spinal cord in the chest to the bowel. Your doctor may think it better to cut this nerve in a procedure called a splanchnicectomy, rather than just inject the nerve ( a nerve block).
This is a small operation under a general anaesthetic. You might have it during other surgery (for example, bypass surgery).
Sympathetic nerve block
Gallbladder cancer may press on the sympathetic nerve chain in the chest. The nerve block for this nerve is called thoracoscopic sympathectomy. You have a general anaesthetic or a sedative for this procedure.
The surgeon makes a few small cuts between your neck and breastbone. They pass a thin tube called a thoracoscope into the cuts. The tube has a camera, eyepiece and light. The surgeon can look inside the body and find the sympathetic chain nerves to inject or cut them.
There aren’t usually many side effects after nerve blocks. You may get low blood pressure or feel light headed if you stand up too quickly. This problem usually gets better over a few days.
Other ways of controlling pain
There are many ways you can help to control pain. Your pain may seem worse if you are anxious or worried. It can often seem worse at night when you can't sleep and there is nothing else to distract you. You may like to try:
- relaxation - listen to some calming music and think of somewhere nice you would like to be
- breathing slowly and deeply when you are tense
- changing your position at least every two hours to prevent stiffness and sore skin
- massage - ask your family or friends to gently massage your back, hands or feet
- hot or cold packs (wrap them in a soft towel so you don't damage your skin)
- watching TV, reading or chatting to take your mind off any pain
These aren’t cures but they can help you to take some control over your pain. It can make it seem better for a while.
If you can't sleep, learning relaxation exercises can be very helpful. Don’t get over tired as this will keep you awake.
Visitors are a good distraction but it may be better to see people more frequently for a short time if possible.