According to a recent survey conducted by National Institute of Cancer Prevention and Research, the total estimated number of people living with any type of Cancer in India are around 2.25 million and every year, new cancer patients registered are over 11 lakh 57 thousand.
More than 75% of these Cancer patients experience some kind of pain during the course of their illness which can be due to the disease itself or due to the treatment side effects. Effective management of this pain is very important to make the patients comfortable during these terminal years of their lives.
Cancer pain is a mixed type of pain i.e. it has both Nociceptive and neuropathic components. Some of the causes of Cancer related pain are:
- Somatic pain due to the Local cancerous growth: Sharp pain at the area of the cancerous growth
- Visceral pain if Cancer of hollow organs like stomach, Intestine: Piercing or dull aching type of pain in the abdomen
- bone pain due to bone metastasis: Sharp pain over the involved areas specifically on movements.
- Neuropathic pain due to nerve compressions or infiltrations of tumors: Sharp radiating pain over the area of distribution of the nerve.
- Treatment-induced like Post-Chemotherapy or Radiation therapy: Burning type of pain
- Metabolic and Endocrine components
Thus, management of Cancer pain requires a comprehensive approach and that’s why came the concept of Palliative care.
PALLIATIVE CARE is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, like Cancer, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
JEEVISHA protocol for management of Cancer pain
- Medications: World Health Organization( WHO) proposed a strategy in 1986 known as WHO Analgesic ladder which laid down the analgesic path for the effective management of Cancer pain. Over the years, it has undergone several modifications and is currently applied not only for managing cancer pain but also acute and chronic non-cancer painful conditions due to a broader spectrum of diseases such as degenerative disorders, musculoskeletal diseases, neuropathic pain disorders, and other types of chronic pain. ( pic of WHO Ladder latest)
On more important aspect of Palliative care is management of the associated symptoms like nausea, vomiting, constipation, diarrhoea, dysphagia etc.
At JEEVISHA Pain Clinic, we follow the most updated protocol for the management of cancer pain.
- Cognitive Behavioural Therapy: Psychotherapy, especially, CBT plays a very important role in maintaining the psychological health of the patient and boosting the morale of not only the patient but also the close family members.
- Fluoroscopy guided Sympathetic ganglion Chemical/Radiofrequency neurolysis
- Stellate ganglion
- T1/T2 Sympathetic ganglion
- Coeliac plexus
- Splanchnic nerve
- Superior/ Inferior Hypogastric plexus
- Ganglion impar
- Intercostal nerve Chemical/Radiofrequency neurolysis
- Intrathecal Pump insertion
- Continuous epidural drug delivery system implantation
- Spinal cord stimulator
- Intrathecal chemical neurolysis