Beating Cancer Pain

Not everyone with cancer experiences pain, but some cancer patients do. Most cancer pain is caused by the cancer tumor pressing on bones, nerves or other organs in the body. The tumor can also release chemicals that can cause pain; the body's reaction to these chemicals can likewise cause pain. In some cases, cancer treatment causes pain. For example, some chemotherapy drugs can cause numbness and tingling in the hands and feet. Radiation therapy can cause skin redness and irritation.

The degree of cancer pain varies from mild to severe, and is commonly described as chronic, i.e. a constant pain that lasts throughout the day. Fortunately, most cancer pain can be controlled by medications depending on the severity of the pain. If pain occurs, there should be prompt oral administration of drugs in the following order: nonopioids (aspirin and paracetamol); then, as necessary, mild opioids such as tramadol; then strong opioids such as morphine, oxycodone, and fentanyl until the patient is free of pain.

Opioids are a class of medications commonly prescribed to relieve pain. Classified as narcotics, strong opioids can only be prescribed in the Philippines by physicians who have been issued an S2 license and special Yellow Prescription Pad by the Philippine Drug Enforcement Agency (PDEA).

About 65 percent of cancer patients on prescribed opioid medications still experience sudden flares of sharp, stabbing, aching or radiating pain. This is called breakthrough cancer pain (BTCP). BTCP can generally be divided into two categories. Spontaneous BTCP has no evident precipitating event. On the other hand, incident BTCP has an evident precipitating cause or event, such as walking, sneezing or coughing.

Often of sudden onset, short duration and more moderate to severe, BTCP usually starts and intensifies quickly (in approximately three minutes) and lasts around 15 to 30 minutes. Some patients describe BTCP as “excruciating and extremely unbearable pain,” which pushes them to the point of “wanting to die.” BTCP is usually associated with significant levels of phys- ical discomfort, negative effects on patients’ ability to engage in their usual activities, and diminished overall quality of life.

BTCP is not the same as the chronic “background” pain of cancer. As such, BTCP requires a different management approach. Although BTCP is a known medical condition, there is low awareness about it among healthcare professionals. This has resulted to suboptimal management of BTCP. Moreover, there is challenge in distinguishing between “background” pain and breakthrough cancer pain.

It is fitting that the first column for our “Beat That Cancer Pain” advocacy comes out in the month of October, which is Breast Cancer Awareness Month. Through this advocacy, we aim to increase awareness on and enhance the management of cancer pain.

Dr. Eunice Theres A. Cutillar is a consultant medical oncologist at the Asian Hospital and Medical Center. Beat That Cancer Pain (BTCP) is a health information initiative of cancer specialists and patient groups in collaboration with A. Menarini Philippines, Inc. For more information, please visit Beat That Cancer Pain Facebook.