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By Molly Adams
September 11, 2019

When it comes to treating cancer pain, there isn’t a one-size-fits-all approach. Patient preference, allergies and potential drug interactions with other therapies all impact which approach your doctor recommends.

“A lot of patients assume opioids are the only option, but there are many ways to help manage pain and increase quality of life,” says pain management specialist Uzondu Osuagwu, M.D.

Here, Osuagwu shares six options you may not be aware of.

1. Anti-inflammatory drugs
“When a tumor invades bone, nerves or organs, it can cause inflammation, which can be painful,” Osuagwu says. Taking a non-steroidal anti-inflammatory drug like Celebrex or meloxicam can offer relief. Ibuprofen and acetaminophen can help treat less severe pain and are available over-the-counter.

“Although these drugs can help control inflammation, they may also affect platelet function and may mask fever, so they may not be recommended for patients on chemotherapy, immunotherapy or certain clinical trials,” Osuagwu adds. That’s because patients on these treatments are more susceptible to infection or bleeding if platelet counts drop.

“Pain management is part of a multidisciplinary team approach to cancer care,” Osuagwu says. “I routinely work with a patient’s oncologist before recommending a new pain treatment to ensure there aren’t concerns about negative reactions.”

2. Muscle relaxers
Sometimes cancer treatment causes pain. For example, patients who’ve had radiation therapy may develop scar tissue near the treatment site, which can cause muscle tightness. Muscle relaxers can help relieve that tightness, Osuagwu says.

Patients may also have pain that has nothing to do with their cancer treatment, like pre-existing back pain or muscle spasms. Muscle relaxers can offer relief in those cases as well.

“We want to make you as comfortable as possible when you’re going through treatment, so it’s important to tell your care team about any and all pain you’re experiencing,” Osuagwu says.

3. Steroid injections
Steroids like triamcinolone and dexamethasone mimic your body’s natural response to inflammation and can help ease more severe joint pain from arthritis, or pain from herniated discs or spinal cord compression. Osuagwu explains that during this treatment, steroids are injected directly into the problem area with the help of an X-ray to precisely target the pain. They typically offer two to three months of relief.

Like non-steroidal anti-inflammatory drugs, steroids can mask fever or suppress the immune system, Osuagwu says, so in some cases they may not be recommended for patients on immunotherapy or clinical trials.

Because steroids can also cause an increase in blood sugar, patients with diabetes should talk with their endocrinologist to control blood glucose.

4. Neurolytic procedures
Patients with cancer in the abdomen or with carcinomatosis (which is when cancer has spread widely throughout the body) may have severe pain caused by tumors pressing on the spine or organs. In those cases, a neurolytic procedure may help. With this method, alcohol is injected around the nerves that are causing pain. The alcohol burns off the nerves and prevents them from sending pain signals to the brain.

“The pain will likely return when the nerves grow back, but that usually takes two to three months,” Osuagwu says.

5. Intrathecal drug delivery
If oral medication or steroid injections aren’t enough, intrathecal drug delivery may help. This approach delivers medicine such as morphine through a catheter inserted directly into your spinal fluid.

To determine if implanted intrathecal drug delivery is right for you, your doctor will inject a single shot of medicine into your spinal fluid. If your pain is relieved by 50% or more over five to seven days, you may be fitted with the pump.

“If you do have the pump implanted, it will need to be refilled with medication every few months,” Osuagwu says.

6. Spinal cord stimulation
Spinal cord stimulation may help patients with extreme nerve pain like burning, stabbing, or tingling that isn’t relieved by medication. “Similar to a pacemaker, spinal cord stimulation uses an implanted battery-operated device to deliver mild electrical signals to the spine,” Osuagwu explains. The electrical signals modify peripheral input from painful areas, which masks pain signals before they can reach the brain.

Patients undergo a five-to-seven-day trial before the spinal cord stimulator is implanted. During the trial period, electric wires are placed into the dorsal column of the spinal cord or dorsal root ganglion through a small incision in your skin. The wires are attached to an external battery pack that can be worn on a belt. The goal is for you to feel like your pain has been reduced by at least 50% before the stimulator is implanted.

While this therapy won’t eliminate all pain, it can drastically reduce and change your perception of pain and improve your quality of life.

“There are a lot of options for managing pain, but the right treatment depends on your pain and your treatment plan,” Osuagwu says. “That’s why it’s important to talk with your care team, so they can find the approach that’s best for you.”

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