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Research into treatment of cancer pain

Coping with cancer

This page tells you about research into the causes, prevention and treatments of cancer pain. You can use the following links to go straight to sections about

 

Why we need research

All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that

  • We can be sure they work
  • We can be sure they work better than the treatments that are available at the moment
  • They are known to be safe
 

The research process

At first, treatments are developed and tested in laboratories. For safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If we say a treatment is at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.

Tests in patients are called clinical trials. The trials and research section has information about what trials are, including information about the 4 phases of clinical trials. All new approaches are the subject of ongoing research. Until studies are completed and new treatments are found to work, these treatments cannot be used to treat cancer pain.

 

About research for cancer pain

A huge amount of research is going on into different types of cancer and treatment. There is also research into pain control and how we feel pain. A trial in breast cancer is looking at why some women have long term pain after breast surgery. So far the researchers have found that having chronic pain before surgery, the type of surgery you have and feeling anxious and depressed can affect the pain you have shortly after surgery. The researchers are continuing to follow up the women who took part in the study to learn more about how they recover after surgery. You can find out about the trial for long term pain in the clinical trials database.

Research is also going on into developing new drugs. Research has identified specific pain receptors on cells. Drugs are being developed to block the receptors and stop pain impulses being produced. Researchers have identified different receptors for nerve pain, which explains why nerve pain is hard to treat with conventional painkillers.

Researchers are looking into different approaches to treating cancer pain. Doctors usually treat pain by starting with simple painkillers such as paracetamol, and then giving weak opioids (such as codeine) if you are still in pain. If this doesn't work, doctors then prescribe strong opioids such as morphine. But starting strong opioids straight away may mean that people have their pain controlled much quicker. The aim of the TVT - Two Versus Three Step - study is to see if people starting strong opioids straight away have better pain control and no more side effects than those who start on weak opioids.

There is also research into how people feel pain and how it affects your everyday life. We know that fear, depression and tiredness can all make pain feel worse. We also know that people feel and respond to pain in different ways and that this can make a difference to how they respond to painkillers. And there is research into how pain is assessed by doctors and nurses, and whether this affects how well the pain is controlled. We still need more research into

 

Assessing cancer pain

Many people with cancer have pain at some point. If pain is properly assessed, it is more likely to be well controlled. A team of researchers in Edinburgh have developed a method of helping doctors and nurses to measure cancer pain. It is called the Edinburgh Pain Assessment Tool (EPAT). There is also a training course for doctors and nurses, which aims to help them understand and treat pain. The EPAT study is looking at whether the training and the new assessment tool can help doctors and nurses measure and treat cancer pain better.

The researchers hope that using this tool, and giving staff the extra training, will help hospitals to provide the best pain relief for patients as quickly as possible.

The EPCRC - CSA study is looking at getting patients to use a portable computer to answer questions about pain and other symptoms of cancer. Researchers are looking for better ways to record these symptoms, and the way they affect daily life.

 

New drugs

There are too many drugs being researched to list them all here. This is a selection of drugs that have recently been licensed or are the subject of current research.

There is information about

Capsaicin

This fairly new painkiller comes from the red chilli pepper. It is called capsaicin (Axsain or Zacin). It is a cream you put on your skin to relieve tingly or burning pain, known as nerve pain. The idea is that the burning sensation you get when you put the cream on desensitises that area to pain. This cream is available on prescription in the UK for arthritic pain, nerve pain called neuralgia and peripheral neuropathy, which can be a lasting effect of some cancer drugs. If you have tried other drugs for this type of pain and they haven't helped, it may be worth discussing capsaicin with your doctor.

Bisphosphonates for bone pain

Bone pain and fractures can be a problem in advanced cancer. Bisphosphonates are drugs that are used to treat these problems. These drugs bind to areas where bone has been destroyed. This slows down the damage caused by cancer cells.

There are a number of new bisphosphonate drugs in clinical trials. They include ibandronate and zoledronic acid (Zometa). You can find details of trials using bisphosphonates on our clinical trials database. Type 'bisphosphonate' into the free text search box.

Sativex

Researchers are looking at a drug called sativex for cancer pain that cannot be controlled with other strong painkillers. The main active ingredients of Sativex are tetrahydrocannabinol (THC) and cannabidiol (CBD). Both of these ingredients come from the cannabis (marijuana) plant. To find trials using sativex, type 'sativex' into the free text search box on our clinical trials database.

Pregabalin for bone pain

Pregabalin (Lyrica) is a drug that is used to treat nerve pain. It works very much like gabapentin which is another anti convulsant drug. Pregabalin is being looked at in a trial as a treatment for bone pain alongside radiotherapy. You can find details of this trial on our clinical trials database. Type 'pregabalin' into the free text search box.

Ketamine for nerve pain

Ketamine is an anaesethic drug when you have it in high doses. The KPS study is looking at adding a low dose of ketamine to other painkillers to see if it can help control nerve pain. Research has found that people who have nerve pain suffer from more anxiety and depression. So the researchers also want to find out if it helps improve anxiety, depression and quality of life.

 

Research into radiotherapy for cancer pain

Radiotherapy is commonly used to treat cancer pain and for many people it works very well. In some people it does not get rid of the pain though. The SC20 trial is looking at whether it is useful to have a second course of radiotherapy for pain caused by cancer that has spread to the bone. The SYSTEMS study wants to find out how helpful radiotherapy is for people with mesothelioma in the chest who have pain.

 

Radiofrequency ablation

Radiofrequency ablation uses heat to kill nerves. The doctor puts a small catheter through a cut in the skin. The tip of the catheter produces heat using radio waves. The heat is directed straight at the nerves. This treatment is still under investigation and there have been mixed results. One review found that there is some evidence it may help with chronic neck pain, but little evidence that it helped with other types of back pain. It is sometimes used to treat pain produced by pressure on the nerves between the ribs (intercostal nerves).

 

Electrical Nerve Stimulation (TENS)

TENS stands for Transcutaneous Electrical Nerve Stimulation. Small pads are stuck onto the skin in the area of pain, or on your back. These release a small electrical charge. This causes a tingling feeling in your skin. Stimulating the nerves that run up the spine to the brain blocks the nerves carrying pain messages. Some studies have shown that TENS may be helpful for pain control but more studies are needed. A small UK trial that reported in 2010 looked at TENS for bone cancer pain. It found that TENS could relieve pain for some people with cancer that had spread to the bone, particularly on movement. But larger trials are needed.

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Updated: 23 July 2013