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Other ways of treating cancer pain

Coping with cancer

As well as painkillers, there are other ways to help control cancer pain and this page tells you about them. There is information about

 

Cancer treatments

Cancer treatments can help to reduce pain by shrinking a tumour and reducing pressure on nerves or surrounding tissues. When cancer treatment is given with the main aim of reducing or getting rid of symptoms rather than curing the cancer, it is called palliative treatment. Treatments used in this way include

Use the links above to find information about each treatment.

You may 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.

You may be able to cut down on your painkillers after cancer treatments. But the treatments can take a while to work. It can take several weeks to get the full benefit. So you will need to carry on taking your painkillers in the meantime.

Chemotherapy or biological therapies can shrink many types of cancer to reduce symptoms such as pain. 

Hormone treatments can shrink some types of advanced cancer such as breast cancer, prostate cancer, womb cancer and kidney cancer.

Radiotherapy can give very good long lasting pain control for certain types of cancer pain such as bone pain. The treatment kills the cancer cells so that the tumour shrinks. The affected bone then begins to heal and strengthen itself. The pain may ease to some extent or may go completely. When treated with radiotherapy, about 3 out of 10 people (30%) with pain from cancer that has spread to the bones will have no pain within a month. Another 4 out of 10 people (40%) will have pain that is half as bad as it was. Doctors often use radiotherapy to treat bones that have fractured because they have been weakened by cancer (pathological fracture). Radiotherapy can also reduce pain caused by spinal cord compression.

Radiofrequency ablation (RFA) uses heat made by radio waves to kill cancer cells. The electrical energy heats up the tumour and kills the cancer cells. You have RFA through a probe that goes through your skin into the tumour. It is quite a new treatment and at the moment only a few specialist centres offer it. But some research has shown that it can control pain caused by some types of cancer.

 

Surgery

In some situations surgery can be used to control pain. A surgeon may 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.

 

Injecting painkillers into the fluid around the spine

This may be called an epidural, intrathecal anaesthetic or spinal anaesthetic. To give painkillers in this way a small tube (called a catheter) is put into your back and into the area around the spinal cord. The painkiller is continuously injected through the tube into your spine. If you are having a big operation for your cancer this may be the best way to control your pain. It will give good pain control for up to 24 hours after your surgery.

This type of pain control is not a first choice to treat non surgical cancer pain. But it can help some people whose pain is not controlled by other ways of giving painkillers, such as tablets or injections. This method can give excellent pain control but it needs a highly experienced doctor (anaesthetist) to do the procedure and highly trained nurses to watch you very closely afterwards. Not all hospitals, hospices or pain clinics are able to provide this service.

Sometimes a small pump is put into the fluid around the spinal cord. It is in your back area just below the waist. It is called an implanted intrathecal pump. Painkillers can be injected into the pump every few weeks. This type of treatment is usually used where other methods of pain control have not worked. You can stay at home with the pump.

 

Nerve blocks

If you have pain that is difficult to treat, your doctor may suggest a nerve block. 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 may 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, named after the nerves that are treated.

The coeliac plexus (pronounced seel-ee-ak pleck-sus) is a complicated web of nerves at the back of the abdomen. It can be responsible for ongoing pain in people with pancreatic cancer and some other types of cancer. To block the pain, the doctor injects local anaesthetic, with or without steroids, or alcohol into the coeliac plexus. Alcohol gives a longer lasting block. It is likely your doctor will give you sedation before you have 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. You have X-rays or CT scans during this procedure, so that 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 (90%) with abdominal cancers can get short and long term pain relief with a coeliac nerve block. Up to 6 out of 10 people (60%) 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 may think it is better to cut the nerves causing the pain, rather than just inject them. This is a small operation and you may have it done during other surgery, such as bypass surgery. You may have a medicine to make you drowsy. 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.

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 (pronounced splank-nik-ectomy). It can reduce pain for many people.

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 will 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 your body 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.

 

Strengthening painful bones

If cancer spreads to the bones it 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 have developed ways of treating bones affected by cancer, by using special cement to strengthen them. These relatively new techniques are

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. Doctors use the cement to fill parts of bone that have been destroyed by cancer and 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) has issued guidance on percutaneous cementoplasty. NICE says that it can be used 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 and 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 it should only be considered 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.

 

Electrical Nerve Stimulation (TENS)

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. Small pads are stuck onto the skin and they 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 nerves carrying the pain messages. TENS may be worth a try as it is easy to use and has few side effects. You can ask your doctor or specialist nurse if it may be helpful for your type of pain.

 

Acupuncture

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. We have a page about acupuncture in our complementary therapy section.

 

Other ways of reducing pain

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 are anxious or worried. It often seems worse at night if you cannot sleep and there is 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 to prevent them damaging 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 would 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 may all help – some cancer support groups can tell you where to find these services in your area
  • Talking to someone about your pain, perhaps a counsellor, can help to relieve stress and tension and make it easier to cope

These may help you to take some control over your pain and make it seem better for a time. If you can't sleep, learning relaxation exercises can be very helpful. Remember not to get too tired. Visitors are a wonderful distraction, but it is often better to see people for short periods of time when you are not well.

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Updated: 8 July 2013