June 21, 2024

Take targeted action against cancer pain

Oncologic pain is a heterogeneous phenomenon with somatic, visceral, and neural components. Effective treatment of cancer pain must take this variability into account and address the individual components of pain with appropriate means.

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“The best prerequisite for adequate treatment of tumor pain lies in a mechanistic approach to the highly heterogeneous phenomenon of ‘cancer pain’,” says Dr. Oscar de Leon Casasola, MD, chief of pain medicine at Roswell Park Comprehensive Cancer Center in Buffalo, New York. Cancer pain can occur as somatic, visceral, neuralgia, or in mixed forms. Physical pain, for example, comes from metastases in the muscles (eg in the chest wall in lung cancer) or in the bones (multiple myeloma, lung or prostate cancer, etc.). Visceral pain is caused by, for example, pancreatic cancer or liver metastases with capsule expansion. However, once the lymph nodes are affected, the pain is no longer purely visceral, says De Leon Casasola. Radiation-induced cystitis or enteritis also falls into the category of visceral pain. Neuropathic pain arises on the one hand from tumor invasion of nerve structures, but also from pain induced by chemotherapy or as part of postoperative pain syndromes, such as those that can occur after thoracotomy or mastectomy. Diagnostic differentiation is easy as pain resulting from tumor invasion can be assigned to a specific nerve supply area or specific skin areas. However, neuropathic pain can also occur in paraneoplastic syndromes. In such cases, the (differential) diagnosis is complex and must be left to a specialized center. In general, neuropathic pain in oncology patients is more a result of the treatment than the disease.

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However, risk factors for uncontrolled cancer pain are known. An evaluation of more than 300 consecutive patients performed in a pain clinic identified radiation therapy, analgesic prescriptions prior to presentation to a pain therapist, neuropathic pain, a high need for emotional support, and high scores on the Brief Pain Inventory (BPI). Overall, the authors of this work note that there is still significant room for improvement in the treatment of oncologic pain.1

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