Cancer Pain Syndrome Due to

Tumor Infiltration and After

Therapy

DR. dr. Rita Viver Pane SpKFR

RS Haji Surabaya
Source of pain cancer

Multi-factorial Multidimensional
1. Due to tumor itself 1. Physical
2. Iatrogenic 2. Emotional
3. Debility 3. Spiritual
4. Co-morbidiities 4. Social
5. Other causes
Due to tumor itself
• Compression (of nerves/nerve plexus/spinal cord/blood vessels
causing ischemia
• Infiltration (soft tissue/nerve/bone)
• Streching (liver capsule)
Infiltration of tumor
Nociceptive pain Neuropathic pain ( 9% )
• Damage/comporession/infiltrati
• Somatic (35%) : - soft tissue on to the nerves
- bone • Damage/infiltration to the nerve
• Visceral (17%) • Sympathetically mediated pain
“I am afraid not of cancer but pain”
• 1/3 of cancer patien experience • Optimal pain control may hasten
pain a return to normalality activity
• 2/3 of advanced cancer suffer
from pain • Inadequate pain control,
• 1/3 have moderate to severe profound alterationin in all
pain aspect of wellness
Management of cancer pain
Multimodal
- Pharmacology
- Non pharmacology
- Interventional pain management techniques
Pharmacotherapy in Cancer Pain

• 70 – 90 % get adequate pain relief by oral or transdermal treatment

• 10 – 30% : need more invasive procedures

WHO analgesic ladder

• Step 1 : mild to moderate pain (NRS : 1 –

3)
• Step 2 : moderate to severe pain (NRS 4
– 6)
• Step 3 : severe pain (NRS : 7 – 10)
Myths in Cancer Pain
• Pain is an inevitable part and • Morphine as a last resort
parcel of cancer • Morphine causess intractable
• All pain cancer due to cancer side effect
itself • There is no need to give other
• Analgesics should be taken on analgesic with morphine
SOS
• Morphine is panacea for all
cancer pain morphine is the
cause of respiratory depression
and hasten death
In Fact
• Pain will be effectively controlled
(70-90%) by oral pharmacology
as WHO ladder
• Pain in cancer due to
multifactorial (tumor itself,
iatrogenic, debility, co morbid
condition
• Analgesic should be prescribe on
round the clock basis with
provision for breakthrough pain
not on SOS basis
• A single anallgesic may not be
adequate to alleviate all the
pains
• Rationale use of morphine has
been found to be safe and
effective
• Morphine is consider as a
wonder drug and gold standart
for cancer pain management
• Morphine is frequenly combine
with step 1 analgesic
Interventional Pain Management in Cancer
Fourth Step in WHO analgesic ladder
New adaptation of the analgesic ladder
Interventional Pain Management in Cancer
• Nerve blocks
• Spinal (epidural and sub arachnoid) administration of local
anesthetics, opioids
• Spinal cord stimulation
• Surgical intervention
Conclusion
• Pain is one of the most common and distressing symptoms in cancer
• Cancer pain is multifactorial in etiology, multidimensial in nature, and
may be mixed nociceptive-neuropathic in nature
• Cancer patient may have pain at more than one site and the
pathology may be different at different site in the same patient
• 70 -90% pain might be controlled by optimal pharmacotherapy
• 10 -30% remain by intervention management
Hopefully
With optimal pharmacotherapy and intervention management
no more fear and distress in cancer patient

All people have a right to be happy and wellness