Pain and Cancer: A Guide to Understanding and Treating the Most Dreaded Symptom

Pain and Cancer: A Guide to Understanding and Treating the Most Dreaded Symptom

Our Medical Director, Jorge Orduña, tells us today in his podcast Piratas del Dolor the keys to a subject of vital importance for thousands of people: pain in oncology patients. In this episode, Dr. Orduña talks to Dr. Inés González, a medical oncologist at the Hospital Clínico Universitario, to give visibility to a symptom that is often relegated to the background, but which is fundamental for quality of life and, according to recent studies, even for patient survival.

The following is a summary of the most relevant points of this meeting for patients, relatives and professionals.

Pain is not an inevitable consequence of cancer

One of Dr. Gonzalez’s most powerful messages is the need to break the myth that “having cancer means having pain”. Today, medicine has a sufficient therapeutic arsenal to control pain in the vast majority of cases. Not settling for suffering is the first step: symptom control allows the patient to be in better physical condition to receive and tolerate cancer treatments, which has a direct impact on prognosis.

Identifying the type of pain: The key to customization

Oncologic pain is complex and can have different origins that require different approaches:

  • Pain caused by the tumor itself: Caused by compression of structures, bone invasion or involvement of internal organs (such as visceral pain in pancreatic cancer).

  • Pain due to treatments: Sequelae of surgery (such as chronic pain after thoracotomy), peripheral neuropathies caused by chemotherapy or autoimmune pain resulting from new immunotherapies.

  • Breakthrough pain: Pain that appears suddenly and intensely (for example, when moving or eating) despite having a well-controlled baseline pain. Identifying these peaks is crucial in order to prescribe adequate analgesic “rescues”.

Fear of opioids and the stigma of fentanyl

It is essential to demystify the use of potent drugs in oncology. The opioid crisis in other countries, such as the USA, responds to a social and healthcare context that is very different from that of Spain. In our environment, the use of drugs such as morphine or fentanyl is strictly supervised by specialists. The oncology patient should not be afraid of addiction; these drugs are safe tools that, when properly administered, restore dignity and the ability to enjoy day-to-day life.

Treatments beyond oral medication

When oral drugs are not sufficient or generate too many side effects, advanced interventional techniques are available:

  • Nerve blocks: such as the celiac plexus block for pancreatic cancer, which relieves pain by acting directly on the origin of the nerve signal.

  • Intrathecal infusion pumps: Devices that deliver medication directly into the medullary space at much lower and more effective doses.

  • Bone cementation (Vertebroplasty): Procedure to reinforce vertebrae fractured by metastasis, eliminating mechanical pain immediately.

The surviving patient: The new challenge

Thanks to medical advances, more and more people are overcoming cancer or living with it for many years. However, these “long survivals” can bring with them chronic sequelae of pain. The healthcare system must evolve so that these patients are not left in a “limbo” of care once they have been discharged from cancer, ensuring a specialized follow-up that allows them to live without disabling sequelae.

The need for real interdisciplinary teams

The future of oncology care lies in the creation of fast circuits and units where the oncologist, the palliative specialist and the pain specialist work in coordination (interdisciplinary). The patient should not be in charge of communicating his symptoms from one doctor to another; the system should be the one that manages appointments and treatments in a transversal way, always putting the person at the center of the therapeutic orchestra.

If you or a family member is going through cancer and pain is present, ask for help. Pain control is not just a matter of comfort, it is an essential part of cancer treatment that helps you live longer and better.