TERMINAL CANCER PAIN: THE GOAL OF PAIN THERAPY
Professor Foley says ‘The goal of pain therapy for patients receiving active treatment is to provide them with significant relief to tolerate the diagnostic and therapeutic approaches needed to treat the cancer.
‘For patients with advanced disease, pain control should be significant to allow the patient to function at a level they choose and to die relatively free of pain.’
Professor Foley believes the controversy surrounding the relief of cancer pain is mainly due to the reluctance by patients suffering cancer pain to accept potent drugs — and that of doctors to prescribe them. Doctors often deliberately limit the amount of pain-killers administered because of concern that cancer patients will become addicted.
A physical dependence does sometimes develop to the drugs. But this rarely reaches the level of the physiological dependence of regular drug addicts.
Patients will become physically dependent on a drug. They will develop signs and symptoms of withdrawal. But this isn’t the same as psychological dependence on the drug. We are taught that drugs are bad for people and so doctors are loath to administer them except in very advanced stages of the disease — and even then gradually.
Professor Foley believes the future of pain relief for cancer suffers is brighter. As well as drugs, pain can be effectively interrupted by nerve blocks — placing a needle around the selected nerve and adding a local anaesthetic.
Doctors can also surgically make a lesion at a place in the central nervous system where pain pathways are present and thus disrupt them with a procedure known as a cordotomy.
In the treatment of pain due to cancer, surgery of the nervous system has a relevance not seen in the treatment of benign or non-malignant pain.
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