Pain management techniques developed for other illnesses could be made available to people with cancer, writes MICHELLE McDONAGH
‘FOR TOO long, cancer care has equalled end-of-life palliative care, the hospice and syringe drivers. A whole lot of new technologies have been developed over the past 20 years for the treatment of non-cancer chronic pain and these should be made available to cancer patients.”
So says Dr Declan O'Keeffe, consultant anaesthetist and director of pain medicine at St Vincent's University Hospital, who is the organiser of a major two-day conference, Managing Cancer Pain, which takes place in Dublin this weekend.
In 2009, the European Pain in Cancersurvey, published by Prof Harald Breivik of the faculty of medicine at the University of Oslo, concluded that the treatment of cancer pain across Europe was suboptimal.
He recommended that pain relief should be considered integral to the diagnosis and treatment of cancer and that management guidelines should be revised to improve pain control in patients with the disease.
Last year, the British Pain Society published a paper which reflected on the need to apply non-malignant pain management protocols and technologies which have been developed over the past 20 years to cancer sufferers.
And the final inspiration for this weekend's meeting was the global impact of the Cancer Pain: Assessment, Diagnosis and Management, a book co-authored/edited by Prof John D Loeser, a pain management specialist, and his colleague in the University of Washington, Irishman Dr Dermot Fitzgibbon.
According to Dr O’Keeffe, “There has been a huge emphasis over the last 20 years in developing a wide range of treatments for chronic pain, but in cancer pain the focus has been on end-of-life issues rather than pain and quality- of-life issues as a result of surgery or treatments such as chemotherapy and radiation therapy.
“Cancer treatment has changed completely – there are cures, remission, disease relapses – but many patients with cancer pain problems are not being exposed to the new technologies to treat pain such as stimulators and pumps.
“There is also very little referral of cancer patients to general pain medicine. What general pain medicine is saying to oncology and palliative care is these services are available and they should avail of them for their patients.”
With a much smaller percentage of patients dying from cancer, Dr O’Keeffe highlights the need to develop multi-modal pain management plans for patients. The conference will focus on the future of pain management in cancer treatment and a special symposium has been organised for GPs treating cancer survivors.
Prof Breivik, whose European Pain in Cancersurvey involved more than 5,000 cancer patients, will address the conference on the topic of Cancer Pain in Ireland and Europe: The Problem.
“Everybody thinks cancer pain is well taken care of through the WHO’s updated guidelines for cancer-related pain and the use of morphine-like analgesic drugs, pain-relieving drugs which have been almost freely available in our part of the world for many years,” he said.
“Yet about two-thirds of cancer patients still have quite severe pain and are on treatments that have adverse effects. It’s better than it used to be 30 years ago, but cancer pain is still a major problem.
“It’s a common misunderstanding that if you just prescribe opioids, then cancer pain will be taken care of but this is not good enough. Major efforts need to be made to adjust doses to the optimal level to reduce side effects.”
Experts in a wide range of areas, from the smart economy and neuroscience to spinal cord stimulation and intrathecal pain pumps that deliver medication directly into the spinal fluid, will be contributing to the conference.
Managing Cancer Paintakes place on Friday and Saturday at the Royal College of Physicians, Kildare Street, Dublin 2. For more details, see managing cancerpain.com or contact Brian Deegan on 01-6650300 or bdeegan@mandcgroup.ie