Cancer Pain and Chronic Pain

One of the shortcomings of modern medicine is that many patients suffering from the pain of advanced, untreatable cancer do not receive adequate medication to ease their final days. Studies show that 50% of people with cancer are in pain at the time of their diagnosis, and 90% of those in advanced stages are in pain.

Doctors are beginning to advocate pain relief for all people with cancer who require it, not only for humanitarian reasons but for clinical ones. Studies on rats with lung cancer show that tumors spread more rapidly in animals not given pain medication. Plus, the widespread belief that giving narcotics would addict cancer patients has been shown to be unfounded. Narcotics are much more likely to be addicting when they are taken to provide euphoria than when they are taken to relieve severe pain.

Drugs used to help cancer patients include

• Anti-inflammatory agents such as aspirin and ibuprofen.

• Weak narcotics such as codeine.

• Strong narcotics such as morphine.

• Opiates delivered directly to the spine via an implanted reservoir.

Many patients are offered the option of patient-controlled analgesia, in which they determine their own dosage schedule.

Chronic pain is of three types: lower back pain, migraine, and myofascial syndrome (inflammation of muscles and their fascia). A variety of approaches treat chronic pain:

Biofeedback. A mechanical device detects and amplifies an autonomic body function, such as blood pressure or heart rate. A person made aware of the measurement can concentrate to attempt to alter it to within a normal range. Anti-inflammatory drugs. Stretching exercises. Trigger point injections of local anesthetic drugs into cramping muscles.

The antidepressant amitriptyline raises serotonin levels in the central nervous system, relieving some chronic pain. Transcutaneous electrical nerve stimulation (TENS) places electrodes on nerves causing pain. The patient feels a tingling sensation, then pain relief.

A nerve block is invasive and interrupts a pain signal by freezing (cryotherapy) or introducing an anesthetic drug (neurolysis). Side effects include numbness or paralysis. A dorsal column stimulator consists of electrodes implanted near the spinal cord. ■

natural pain control. Clinical Application 12.1 discusses treatments for severe pain.

H Describe three types of touch and pressure receptors.

^9 Describe thermoreceptors.

^9 What types of stimuli excite pain receptors?

D What is referred pain?

B Explain how neuropeptides control pain.

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