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Cancer pain

Thanks to all who participated in the Jan. 12 chat on cancer-related pain. Read a transcript of the session below.



Expert: Dr. Paul Christo, director, Multidisciplinary Pain Fellowship Training Program, Johns Hopkins University School of Medicine

Can't make the chat? E-mail questions in advance to healthcalendar@baltsun.com

Note: Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

Dr. Christo's previous chat Dec. 15 on headache pain can be viewed here.

 Health Chat: Cancer pain(01/12/2011) 
11:04
Baltimore Sun Health: 
Hi, we'll be starting our live chat at noon, but feel free to add your questions now.
Wednesday January 12, 2011 11:04 Baltimore Sun Health
12:00
Baltimore Sun Health: 
Hi, everyone, welcome to our live chat on cancer-related pain. We're going to get started.
Wednesday January 12, 2011 12:00 Baltimore Sun Health
12:02
[Comment From AnonymousAnonymous: ] 
Thank you for doing the web chat, many of us really need this type of help. I had a bone marrow transplant for recurrent Hodgkin's disease 12 years ago. The pain remains crippling.I've been to pain clinics and many doctors but not much helps. The pain keeps me from working enough hours to be able to support myself. It's nerve pain and throbbing everywhere. It feels like the same pain that begin the day the high dose chemo was started. Like my entire body is being squeezed tightly and on fire. It's worse in my back as my spine collapsed during the year in ICU. I am unable to locate a physician who understands what to do about this long term cancer pain. Everyone else who had the experiment I did has died. My oncologist says he understands cancer, but not the pain long. (Thank God.) I've been through all the doctors my HMO allows for this type of thing. Sir, how do you recommend I proceed in locating someone who may understand this and be able to help? I have been diagnosed with many things including fibromyalgia. But I think they throw me in a category because they don't know what else to do (and so do my doctors.) Cancer is over. But the pain keeps me from living.
Wednesday January 12, 2011 12:02 Anonymous
12:09
Baltimore Sun Health: 
Some facts about cancer-related pain: A University of Michigan Health System study says that 20 percent of cancer survivors at least two years post diagnosis have current cancer-related chronic pain.
Wednesday January 12, 2011 12:09 Baltimore Sun Health
12:12
Drchristo: 
Sure. Happy to help. You're pain could derive from the chemotherapy that you received and/ or you could have pain from a collapsed vertebral body due to the "spine collapse" that you mention. The chemotherapy induced pain may be neuropathic and could respond to drugs liked gabapentin (neurontin), tricyclic antidepressants (nortriptyline), or even opioids (morphine, oxycodone, fentanyl patch). If the collapsed vertebra is also causing pain, there are procedures that can be helpful. Both procedures (vertebroplasty and kyphoplasty) involve injecting cement into the bone to reduce pain and stabilize the fracture. The fracture should be more recent in order for the pain response to be better. Some organization that might help are: The American pain Society, The American Academy of Pain Medicine, and the American Pain Society. You can reach out to academic insitutions like Johns Hopkins or others in your particular region of the country.
Wednesday January 12, 2011 12:12 Drchristo
12:14
[Comment From MarkMark: ] 
I have been on Androgen Deprivation Therapy (ADT) for 2 1/2 years. I've had a local recurrence in the prostatic bed and regional lymph nodes, which was treated with radiation and chemo. Three months later, my PSA rose from .5 (after treatment) to 5.68. I'm experiencing more pain than before, but not all the time and mostly at night. The pain is mostly contained in the ribs, thighs, and lower back. Could this be attributed to the ADT or progression of my cancer? I haven't gone in for a scan yet since these new developments. Thank you for addressing this. Mark
Wednesday January 12, 2011 12:14 Mark
12:21
Drchristo: 
If pain recurs or worsens in patients with cancer, the first thought is that the cancer may have spread or is expanding. Therefore, I would talk to your oncologist about imaging your spine to determine whether the turmor exists in the bone (spine, ribs). Low androgen levels may contribute to worsening pain in part by presdisposing one to osteoporosis and subsequent fractures. Pain mainly at night is also concerning for possible cancer.
Wednesday January 12, 2011 12:21 Drchristo
12:22
[Comment From GuestGuest: ] 
My father has neuroendocrine tumors on his liver and has constant pain. Does anyone have these tumors and experience this kind of pain.
Wednesday January 12, 2011 12:22 Guest
12:25
Drchristo: 
Yes. Others suffer from pain due to tumors in the liver or liver disease. This type of pain is termed, visceral pain because it involves an organ in the body (liver). Opioids are the mainstay of cancer pain control, but nerve blocks can also be helpful. Your father may benefit from an evaluation by a pain specialist to determine which medications may be the most useful, and whether he may be a candidate for a nerve block called a celiac plexus block.
Wednesday January 12, 2011 12:25 Drchristo
12:26
[Comment From ....: ] 
Can you discuss nondrug therapies for cancer pain
Wednesday January 12, 2011 12:26 ..
12:26
[Comment From sarasara: ] 
It's been 12 years! Is this ever going to end? I swim, walk, stretch and do physical therapy. Other then heavy drugs, is there anything else I can do?
Wednesday January 12, 2011 12:26 sara
12:39
Drchristo: 
Sure. Depending on the location of the cancer, there are procedures that help treat bone collapse in the spine (vertebroplasty and kyphoplasty), radiofrequency turmor ablation (attempting to destroy the cancers located in the liver, pelvis, pancreas, kidneys), surgery, radiotherapy (radiation), chemotherapy, and even antibiotics can reduce pain in cases of infection or absecess.

Pain specific procedures include epidural injections, intrathecal injections or infusions (place a small tube in the fluid containing space that surrounds the spinal cord and deliver medications directly to the spinal cord), implantation of a pain pump that contains medication which is delivered directly to the spinal cord, doing certain nerve blocks of the sympathetic nervous system with a nerve destruction medication (often alcohol) that can reduce pain in specific regions of the body for a longer period of time, and even doing selective nerve blocks with local anesthetic.
Wednesday January 12, 2011 12:39 Drchristo
12:39
[Comment From MOMO: ] 
glioblastoma multiform - is there any specific sort of pain associated with this type of cancer? (other than side affects from radiation and chemotherapy)
Wednesday January 12, 2011 12:39 MO
12:43
Drchristo: 
Patients often report a headache. The headache can worsen to the point that it feels like an intense pressure and the head will explode. Treatments include surgery, radiation, and chemotherapy. Opioids can be helpful in lessening the intensity of pain.
Wednesday January 12, 2011 12:43 Drchristo
12:44
Baltimore Sun Health: 
Dr. Christo, what cancer types are more prone to pain than others. Breast cancer vs. bone cancer, etc.
Wednesday January 12, 2011 12:44 Baltimore Sun Health
12:50
Drchristo: 
Bone cancer has the highest rate of pain -85%, followed by cancer of the mouth and then cancers of the urinary tract and genitals. Leukemia is associated with the lowest percentage of patients with pain-5%. Remember that cancer pain increases in frequency as the disease progresses, so pain control earlier can reduce the burden of pain later.
Wednesday January 12, 2011 12:50 Drchristo
12:52
[Comment From ernest d.ernest d.: ] 
my sistyer is having major pain in stomach because of melenoma that spread to her liver. started as rectal melenoma
Wednesday January 12, 2011 12:52 ernest d.
1:00
Drchristo: 
Pain in the liver or stomach is called visceral pain and may be controlled with a specific nerve block called a celiac plexus block. The celiac plexus represents a weblike group of tiny nerves that receives pain signals from the abdomen (stomach, liver, spleen, gallbladder, pancreas, intestines). The nerve block is done under x-ray or even CT, uses local anesthetic (like novacaine), then a nerve destroying medicine (alcohol) may be used to provide months of pain relief. Like any nerve block or surgery, it has certain possible side effects and complications, but it's quite safe if done by an experienced physician. Of course, medicines by mouth can also be used for pain control if the patients prefers to avoid injections or if the injection doesn't provide sufficient relief.
Wednesday January 12, 2011 1:00 Drchristo
1:01
[Comment From GuestGuest: ] 
Thank you doctor. May God bless all of you, keep you in has favor and help you with your pain.
Wednesday January 12, 2011 1:01 Guest
1:01
Baltimore Sun Health: 
That's all we have time for today. Thanks for all of your great questions. We'll be back two weeks from now to discuss another pain topic.
Wednesday January 12, 2011 1:01 Baltimore Sun Health
1:02
Drchristo: 
Thank you for your questions. I look forward to hearing from you in two weeks.
Wednesday January 12, 2011 1:02 Drchristo
1:15
 

 
 
 
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