Pain is a frequent disorder in cancer patients and has a strongly negative impact on a person's quality of life, limiting the possibility of performing daily activities, increasing care needs and creating additional psycho-emotional suffering.
Pain affects about 30% -50% of cancer patients and becomes particularly frequent in the most advanced stages, when 70% -90% of patients suffer from it. Fortunately, in most cases it is possible to control cancer pain by taking pain medication, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opiates.
Cancer pain can occur at different stages of the disease:
Why does cancer pain occur?
The pain related to the presence of a tumour can be linked to the compression of tissues or nerves by the tumour mass or metastases, to the development of an infection (as a complication of the disease or the treatments taken to counter it), to the damage produced to the tissues by surgery or to the side effects of chemotherapy and radiotherapy.
Pain does not always arise in areas of the body where the primary tumour or its metastases are present. On the contrary, it is sometimes felt in locations distant from the neoplasm (reflex pain) and even if the diseased organ has already been surgically removed (phantom limb syndrome).
How does it manifest itself?
Cancer pain can be:
The presence of very intense pain can cause cancer patients and family members to worry and become discouraged, considering it a sign of disease worsening. In reality, the intensity of pain is not necessarily related to the severity of the disease, but also to the type of cancer present, the organs involved and its location. Small tumours that compress a nerve, for example, can cause much more pain than others of greater aggressiveness and extension positioned in less "sensitive" areas.
Fluctuations in the intensity of cancer pain are common. In particular, in patients on treatment and with well-controlled baseline pain, Intense Episodic Pain (IEP), also known as BreakThrough cancer Pain (BTcP), may occur in an extemporaneous manner, which corresponds to a sudden pain of considerable intensity, excruciating, characterized by a duration varying from a few minutes to an hour. In a numerical rating scale from 0 (no pain) to 10 (unbearable pain), IEP can reach scores of 8-9.
IEP can have various triggers: movements that stimulate "critical" body areas, coughs, changes in position, distension of the urinary tract or bowel walls (for example, due to urinary retention or severe abdominal swelling).
Other causes of IEP include: bone metastases, compression of nerve structures, obstruction of hollow organs, lesions of the oral cavity, skin lesions caused by soft tissue infiltration. However, in many cases, it is not possible to identify a precise cause of pain (idiopathic IEP).
Since IEP greatly compromises the patient's quality of life, its treatment is a clinical and ethical priority for the doctors who assist him.
Basic cancer pain is mainly controlled with analgesic drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs) and opiates. When Intense Episodic Pain (IEP) occurs, the doctor may prescribe an additional analgesic therapy, to be taken as needed, to specifically counter the extemporaneous exacerbation.
When cancer pain is linked to the presence of a bulky tumour mass and / or placed in "critical" areas, surgery, chemotherapy and radiotherapy, which reduce the size of the tumour, may also be useful to mitigate it.
In the case of persistent severe pain not attenuated by analgesic drugs or other approaches, it is possible to have recourse to "nerve blocks", that is to the devitalisation of the nerves responsible for the transmission of pain, and to interventions of immobilization of the bones affected by metastasis (cementoplasty and vertebroplasty) which, in addition to reducing pain, decrease the risk of pathological fractures.
Even some behavioural measures can help to give relief: for example, changing position in the bed at least every two hours helps to prevent stiffness, muscle contractions and bedsores, while hot or cold packs have an analgesic effect additional to that of drugs. On the other hand, massages, relaxation and breathing exercises, listening to music and other activities can give relief by distracting from physical pain.
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