Pain & Palliative care
Pain Management
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Leadership in Pain Management
Mahatma Gandhi Cancer Hospital & Research Institute is a pioneer in providing pain management services for cancer patients in Andhra Pradesh. The Pain Management team at the hospital has conducted groundbreaking research in this field, significantly advancing the science of pain medicine. As a result, pain management has become a top priority in comprehensive cancer care.
At MGCH&RI, the belief is that access to pain relief is a fundamental human right. Fortunately, most cancer-related pain can be effectively managed. Pain management is an integral part of the holistic approach to treating individuals at all stages of cancer treatment. The following elements are included in pain management:
Continuous Pain Monitoring
The nursing staff at MGCH&RI is trained in assessing and managing pain. Patients in the hospital are regularly asked about their pain levels. They are encouraged to communicate any pain they experience to their nurses or doctors promptly. Pain intensity is measured on a scale from zero to ten, and every effort is made to provide appropriate pain relief treatments.
Assistance with Home Pain Care
While hospital stays are typically short, cancer patients may continue to experience pain after returning home. MGCH&RI’s outpatient clinics offer support in managing pain through digital consultations with patients and their caregivers.
For over two decades, MGCH&RI has been at the forefront of developing evidence-based guidelines for cancer pain management. These guidelines are the result of rigorous research and contribute to improving the understanding and treatment of pain.
Investigational Approaches
MGCH&RI continues to contribute to the advancement of pain management through research. Key research areas include identifying cancer-specific pain, understanding the neurological origins of pain, examining the relationship between social and psychological factors and pain, establishing accurate pain assessment methods, and determining appropriate pain relief treatments.
Overview of Cancer Pain
Although the actual disease itself does not typically cause pain in most newly diagnosed cancer patients, the fear of pain is common. Pain may become a more significant concern as cancer progresses, with approximately three-quarters of individuals with advanced diseases experiencing some level of pain.
Each person’s experience of pain is unique and may involve physical discomfort, functional impairment, emotional distress, financial challenges, and changes in family dynamics. At MGCH&RI, the cancer care team takes into account not only the physical pain but also the nonphysical stressors, including emotional, financial, and spiritual difficulties. By considering all these factors, the team can make appropriate referrals to MGCH&RI’s Supportive Care Service, which provides psychological consultations, counseling, and support groups to help patients and caregivers navigate ethical decisions and to the Integrative Medicine Service for complementary therapies that may aid in symptom management.
Causes of Cancer Pain
Cancer-related pain can result from the disease itself or as a side effect of treatment. Medical professionals identify the underlying causes of pain through medical history evaluations, physical examinations, and advanced diagnostic imaging techniques.
Pain can be directly attributed to tissue damage caused by tumors pressing on or destroying tissues, bones, or nerves. It can also arise due to blockages in organs or body systems caused by tumors. Additionally, pain can occur as a result of cancer treatment, such as after surgery, chemotherapy, immunotherapy, or radiation therapy.
Different Types of Cancer Pain
Cancer pain can be categorized into different types based on its origin and characteristics:
- Neuropathic Pain: Caused by nerve damage or compression within the nervous system.
- Nociceptive Pain: Arises from ongoing nerve-tissue damage and an inflammatory response. It can be further classified as:
– Visceral Pain: Originating from injury to internal organs, often challenging to localize and may be throbbing, aching, or sharp.
–Bone Pain: Caused by cancer that has spread to the bones or directly affects the bone tissue. It is often described as deep, dull, or aching and may worsen with movement or weight-bearing.
- Soft Tissue Pain: Arises from damage or compression of soft tissues, such as muscles, tendons, or ligaments. It can be described as aching, throbbing, or tender.
- Phantom Pain: Occurs after the amputation of a body part, where the individual continues to feel pain in the missing limb.
- Breakthrough Pain: Intense and sudden episodes of pain that occur despite the use of regular pain medications.
- Procedure-related Pain: Pain that arises during medical procedures, such as biopsies, surgeries, or invasive interventions.
Pain Management Approaches
The pain management team at Mahatma Gandhi Cancer Hospital & Research Institute employs a multimodal approach to address cancer-related pain. The goal is to provide personalized treatment plans that effectively manage pain while considering the individual’s overall health, cancer stage, and treatment goals. Some of the common pain management approaches include:
Medications:
Analgesic medications are commonly used to manage cancer pain. They may include non-opioid analgesics (such as acetaminophen or nonsteroidal anti-inflammatory drugs), opioids (such as morphine or fentanyl), adjuvant medications (such as antidepressants or anticonvulsants), and local anesthetics. The choice of medication depends on the type and severity of pain, as well as individual factors and potential side effects.
Interventional Procedures:
In some cases, interventional procedures may be recommended to target and alleviate specific sources of pain. These procedures can include nerve blocks, epidural injections, radiofrequency ablation, and spinal cord stimulation. These techniques aim to interrupt pain signals or provide localized pain relief.
Physical Therapy:
Physical therapy and rehabilitation can help manage cancer-related pain by improving physical function, reducing muscle tension, and enhancing overall well-being. Physical therapists may recommend exercises, stretches, manual therapy, and other techniques tailored to the individual’s needs.
Psychological Support:
Emotional and psychological support is crucial in managing cancer pain. Counseling, cognitive-behavioral therapy, relaxation techniques, mindfulness, and other psychological interventions can help individuals cope with pain, reduce anxiety and depression, and improve their overall quality of life.
Palliative care
Palliative care is aimed at enhancing the quality of life for patients who have a serious or life-threatening illness, such as cancer. It can be provided alongside curative treatment or on its own. Palliative care takes a holistic approach, considering the person as a whole rather than just focusing on their disease. The primary goal is to prevent or manage symptoms and side effects of the disease and its treatment, while also addressing psychological, social, and spiritual issues. Palliative care can be administered in various settings, including hospitals, outpatient clinics, long-term care facilities, or even at home under the supervision of licensed healthcare professionals. It is available to individuals of any age or stage of the disease.
Who provides palliative care?
Palliative care is typically delivered by specialized healthcare practitioners known as palliative care specialists. These professionals have received special training and certification in palliative care. They provide comprehensive care to both patients and their families or caregivers, focusing on the physical, emotional, social, and spiritual aspects of the cancer experience. Palliative care specialists often work as part of a multidisciplinary team that includes doctors, nurses, dieticians, pharmacists, occupational therapists, physical therapists, psychologists, and social workers. Collaboration between the palliative care team and the oncology care team ensures coordinated care and the best possible quality of life for patients. Palliative care specialists also provide support for caregivers, facilitate communication among healthcare team members, and assist in discussions regarding the patient’s care goals.
What issues does palliative care address?
The physical and emotional effects of cancer and its treatment can vary widely among individuals. Palliative care addresses a broad range of issues, tailoring the care to meet each patient’s specific needs. Some of the common issues addressed in palliative care include:
- Physical Symptoms: Palliative care focuses on managing common physical symptoms such as pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath, and insomnia.
- Emotional and Coping Support: Palliative care specialists offer resources and support to help patients and families cope with the emotional challenges that arise from a cancer diagnosis and treatment. They can address concerns like depression, anxiety, and fear.
- Spiritual Support: With a cancer diagnosis, individuals often seek deeper meaning in their lives. Palliative care experts can assist patients in exploring their beliefs and values, helping them find spiritual peace or acceptance that aligns with their situation.
- Caregiver Support: Family members and friends play a crucial role in cancer care, but they also have changing needs and may experience overwhelming stress. Palliative care specialists provide support to caregivers, helping them cope with their responsibilities and address their own well-being.
When is palliative care used in cancer care?
Palliative care can be provided at any stage of cancer care, starting from the time of diagnosis and continuing throughout the treatment process. It can be integrated alongside curative treatment without interfering with ongoing cancer therapies.
How can someone access palliative care?
The oncologist or a member of the oncology care team should be the first point of contact for inquiries about palliative care. They can assess the patient’s physical and emotional needs and refer them to a palliative care specialist if necessary.
What is the difference between palliative care and hospice?
Palliative care can begin at any stage of cancer treatment, whereas hospice care is initiated when curative treatment is no longer the focus, and the primary aim is to maximize quality of life. Palliative care can help patients and their loved ones transition from treatment-oriented care to hospice care by preparing them for physical changes near the end of life, providing support for emotional issues, and offering assistance to family members and caregivers.
Is there evidence supporting the benefits of palliative care?
Research has shown that palliative care, with its comprehensive approach, is beneficial for the health and well-being of both patients and their families. Recent studies indicate that integrating palliative care into standard cancer care soon after an advanced cancer diagnosis can improve quality of life, and mood, and potentially even extend survival. The American Society of Clinical Oncology recommends that all patients with advanced cancer receive palliative care.
