Cancer Pain
Cancer Pain! What is It?
Pain in cancer patient can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients’ quality of life.
Specific interventional pain management techniques can be an effective alternative for those patients which provides better pain control, allows reduction of analgesics and hence improve quality of life.
Until recently majority of these techniques are considered to be fourth consecutive step following world health organizations (WHO) pain treatment ladder.
However in cancer patients, an earlier application of interventional pain management techniques can be recommended
WHO LADDER PAIN MANAGEMENT
FIRST LADDER: – NON OPIODS AND ADJUVANTS
It includes NSAIDS(pain killers),anti convulsants , anti depressents, steroids etc.
Non–opioid Adjuvant drugs include N-Methyl-D-aspartate receptor (NMDA) receptor antagonists (e.g. ketamine, nitrous oxide), anticonvulsants (e.g. gabapentinoids), intravenous (IV) lidocaine, systemic alpha 2 agonists, magnesium sulphate, beta blockers, antidepressants (e.g. tricyclics, SNRIs).
SECOND LADDER :- WEEK OPIODS AND ADJUVANTS
It includes tramadol, codine etc with other adjuvant drugs.
Adjuvant drugs can be used to enhance the effects of pain medications, treat concurrent symptoms, and provide analgesia for other types of pain. Adjuvant analgesics are particularly useful when evidence of decreased opioid responsiveness is present.
THIRD LADDER: STRONG OPIODS
It includes fentanyl,morphine,buprenorphine etc.
Strong opioids – these include tramadol, buprenorphine, methadone, diamorphine, fentanyl, hydromorphone, morphine, oxycodone, and pethidine.
FOURTH LADDER :- INTERVENTIONAL PAIN PROCEDURES
RADIOFREQUENCY ABLATION OF TRIGEMINAL GANGLION
B) INTERATHECAL INJECTION, EPIDURAL INJECTION,NERVE BLOCKS, ETC CAN ALSO BE PART OF TREATMENT.