Cancer Pain

Of all chronic pain, cancer pain can be the most prolonged and intense. The type of pain experienced, however, is not all-encompassing; it depends on the type of cancer the patient has. As such, Hartford Health Care Pain Treatment Center has comprehensive methods in place to manage each specific patient’s pain, which include anti-inflammatory medications, opioids, antidepressants or SSRIs, and/or membrane stabilizers.

Cancer pain comes in three different types, according to Hartford Health Care’s Dr. Ricardo Taboada, M.D., who is certified in interventional pain management. Somatic pain is localized and is felt as a constant ache or throbbing. Visceral pain originates from soft organs or the thorax, abdomen and pelvis and is frequently experienced with pancreatic cancer. Patients can feel a deep, dull pain that is vague in location, and they often complain of referred pain, where they experience discomfort in areas that are not affected by the cancer. Meanwhile, neuropathic pain is felt as an acute burning, piercing pain lasting for long periods of time. It is sometimes spontaneous and sometimes an intense response to what would normally be non-painful interaction.

“Our goal with cancer pain, as well as any other type of pain, is to improve quality of life and decrease suffering,” Dr. Taboada said. “We aim to have our patients increase their activities of daily living and enjoy the aspects of life that make them feel alive and happy.”

Dr. Taboada said that cancer does not typically become painful until it is well-advanced. And since cancer pain cannot be cured unless the cancer is cured, the main point of care becomes pain management.

If a patient experiences more than one type of cancer pain, other methods of management are used, including neuraxial drug delivery systems, which are placed in the spinal fluid, Celiac Plexus Blocks to stop nerve pain messaging or Calmare therapy.

While much patient pain stems directly from the cancer, Dr. Taboada said chemotherapy reactions can also cause major discomfort and bodily stress. “Chemotherapy-induced peripheral neuropathy (CIPN) may occur in up to 51 percent of individuals receiving chemotherapy,” he said. “The development, incidence and severity of CIPN depend on individual risk factors but also on cumulative dose, treatment duration, drug chemical structure and combination therapies.”

Dr. Taboada cites astonishing results with Calmare therapy in these cases. Calmare, he said, is a state-of-the-art device that scrambles pain messages within the body with non-pain messages, which reduces the patient’s perception of pain intensity.

“I like to think of it as retraining the brain as to what it is supposed to be feeling when the skin is touched versus what it is currently interpreting,” Dr. Taboada said.

The largest barrier to this type of therapy is that many insurances don’t cover it. Dr. Taboada said Hartford Health Care Pain Treatment Center is continually negotiating with insurance companies to provide this service to their patients. “Our goal is to allow this therapy to be available to anyone who might benefit from it.”

On the other hand, Celiac Plexus Blocks are covered by most insurances. They are nerve blocks performed under xray or fluoroscopic guidance which alleviate abdominal and back pain most often experienced in advanced stages of pancreatic cancer. Dr. Taboada said the relief is usually immediate.

Using varied techniques and medications, the pain is managed individually and over time for each patient. There is no one-size-fits-all management plan, and it is important to listen to each patient and come up with a solution that works for each specific body and mind.

“Our goal is to keep people functional. We will often try different medications per patient until we find one they can tolerate. In some cases, we may even perform genetic testing to identify which medications the patient can metabolize normally,” Dr. Taboada said.

One of the largest battles the pain center faces in terms of cancer patients is that patients don’t come to them soon enough, said Dr. Taboada. “It is crucial that patients ask their physicians for a referral to our clinic as early as possible so we can devise a plan before the pain gets too difficult to control,” he said.

As it stands, the medications and methods outlined, when used in tandem depending on the individual’s needs and symptoms, have been proven to help prolong life expectancy and quality of life.

Pain Treatment Center