Cancer Pain

Introduction

Pain is one of the most common, unattended and

unsolved problem for the cancer patients. Major obstacles

or barriers still exist that prevent reduction of pain in cancer

patients. Its management is often hindered by barriers

created by patients and physicians alike. More over,

psychological effects of cancer pain can be devastating. By

avoiding potential barriers and understanding the principles

of pain management and proper drug selection and titration,

one can safely administer adequate pain relief to the patients

in need. Education of patients, families, healthcare providers,

legislators, and law enforcement agencies is needed to

improve the treatment of patients with cancer pain with all

the pharmacologic therapeutic modalities available. So there

is an immediate need to address these issue at all possible

levels. The  pain management is an important goal in the holistic care of patients with cancer.

What is cancer pain?

In simple words, pain in patients caused by cancer disease itself and / or by the diagnostic (investigational) procedures or treatment.

Is it a Public health problem?

Despite major improvements in pain control in the last two decades, it continues to be a challenge to treat. The available data suggests only 50% of patients with cancer are adequately treated.

 

Causes of cancer pain?

The two most common causes of cancer pain are the cancer itself and the treatments you receive to treat cancer.

1. The cancer itself. When cancer causes pain, some probable causes include the pressure of a tumor on one of the body’s organs or on bone or nerves. Sometimes cancer can cause pain when blood vessels become obstructed by the tumor.
2. Cancer treatments. There are a variety of treatments for cancer and some of them are less than pleasant. However, please remember that not all people being treated for cancer experience ALL of the array of side effects of these treatments. A side effect one person feels may never happen to another. It is also very important to remember that many treatment-related side effects can be successfully prevented in some cases, and treated if they occur. More information about managing side effects is explained where each treatment type is discussed.

Some examples of treatment-related pain include:

• Chemotherapy can cause numerous side effects, depending in the medication being used. Some of the more common side effects that cause pain include mouth sores (mucositis), peripheral neuropathy (numb and sometimes painful sensations in the feet, legs, fingers, hands and arms), constipation, diarrhea, nausea, vomiting and abdominal cramps. Some people also experience bone and joint pain from chemotherapy medications and from some medications used to offset the impact of the chemotherapy on blood counts and on the risk of infection.

• Surgical treatments will, in some instances produce pain after they are completed. Your physician and nurse will provide medications and techniques to help you manage surgery-related pain.

• Procedures related to cancer pain, such as biopsies, blood draws, lumbar punctures, laser treatments, etc. can cause pain

No matter what the cause, most types of cancer pain can be managed with drug and non-drug therapies. However, cancer pain is not always adequately managed. While competent health care professionals should assume that people with cancer will need assistance to manage pain and ask you about it, if they do not, you or your family members must speak up and insist on having your pain relieved. Some physicians may not always prescribe the right medications or sufficient doses of the medication. If this happens, ask for more assistance and, if you choose, ask that a pain specialist work with you to develop a plan to manage your pain. Pain specialists are physicians and nurses who are experts in the field of pain management. For more information on finding a pain specialist.

How does pain develop in cancer patients?

There are various factors involved, like

1)    Pain caused by cancer directly (60 – 90%) – this is the more common explanation why pain develops. Here the cancer tissue either invades the neighbouring tissues like bone, bowel etc or compress (invade) the nerves, thereby causing pain.

2)    Pain caused by diagnostic or treatment procedures (5- 20%) – certain procedures like Biopsy or puncture, Chemotherapy, Radiotherapy, and Surgery done by the treating doctors can be painful for the patients.

3)    Indirect causes (10 – 25%) – conditions like infections, lymphoedema etc can independently cause pain.

4)     Other associated diseases (3 – 10%) – conditions which coexist along with cancer like diabetic neuropathy, headaches, osteoarthritis etc can also give rise to pain.

These are reasons why pain develops in a cancer patient. More over there are certain ways in which cancer causes pain which is unique, like

Caused by the cancer

Tumour involvement of the bone

Tumour involvement of viscera

Tumour involvement of nervous system

Caused by anticancer treatment

Post-surgery

Post-chemotherapy

Post-radiotherapy

Who will treat your pain?

Those were the days when your physician or surgeon used to administer the pain killer, and you will be left unsatisfied most of the times. Now we have a dedicated speciality to treat / control the pain to your satisfaction, by utilising advances in the technology non-invasive or invasive .

When the pain treatment should be initiated?

 

Pain treatment should be initiated as soon as the diagnosis is established and treatment is initiated.

Pain speciality is separate from palliative care?

 

If one goes according to definitions, both are different specialities but in cancer pain management both the specialities go hand in hand.

What are the treatment options available?

 

To treat cancer pain various options are available to treating physician like,

Pharmacological (using oral / injectable medicines)

Interventional (using special injections to target the nerves causing pain)

What are the drugs used and their side effects?

 

Various options are available for the physician to treat the pain.

1. Simple analgesics (pain killers) – these drugs will help to relieve the mild to moderate type of pain.

These include,

Paracetamol – commonly used, very safe drug.

Tramadol – stronger than the paracetamol, useful to treat moderate pain. It can cause nausea, vomiting and constipation.

Combination of the above

NSAIDs – these are a class of drugs useful to treat moderate painful conditions. Various drugs are available like, diclofenac, ketorolac, celecoxib, rofecoxib etc.

The side effects are gastric irritation, gastric bleeding, kidney problems etc.

1. Strong pain killers

These are the drugs very similar to street drug like heroine, and are very useful in treating moderate to sever pain.

Morphine – this drug has revolutionised the treatment of cancer pain. It is available in both tablet as well as injection form. It is available only on prescription by a registered practitioner to dispense the drug (approved by the govt).

Side effects are drowsiness, nausea, vomiting, allergic reactions, itching, breathing problems etc. hence it should be prescribed by the physician.

Others like methadone, codeine, etc are available to treat the pain.

Can permanent pain relief be achieved?

 

Yes, to certain extent it is possible to achieve pain relief completely with special interventional techniques. When other modalities of treatment including curative treatment have failed and patient is suffering from intractable pain, one can opt for interventional techniques to treat the pain.

Here a specially trained doctor in interventional pain management does the procedure to destroy selective nerve responsible for the pain, using special drugs or equipments.

What are these procedures?

These include,

1. Gasserian ganglion block – used to treat head and neck cancer pain.

2. Stellate ganglion block – used in treating pain in upper limb caused by cancer of breast, lung etc.

3. Celiac plexus block – used in treating pain caused by cancer of upper abdominal origin.

4. Superior Hypogastric plexus block – used in treating pain of lower abdominal origin.

5. Ganglion Impar block – used to treat pain arising from in around the genital region.

Are these injections simple?

 

These procedures are not simple. These have to be done in an operating room setup where all the monitoring and resuscitation facilities are available.

All these procedures require patient to adequately investigated, and admitted prior to the procedure. If required patient has to be admitted post procedure for observation.

These injections are painful?

 

Yes, most of these injections are done when the patient is awake and hence painful, but the pain can be alleviated by injection of local anesthetic (numbing drugs).

Can the effect be achieved with single injection?

 

No, most of these procedures require two (or more) injections to achieve the results. First a diagnostic injection will be given to see the results like extent of pain relief, and region involved. Only after the success of diagnostic injection a permanent injection (in the form of alcohol / phenol or current) will be done.

Ozone Oxygen Therapy For Cancer

Ozone Therapy is a special form of cancer oxygen used to kill and stunt the growth of cancer cells.  Oxygen usually prefers to come in pairs: O2. However, oxygen occasionally comes as a triad: O3.  O3 or Ozone is much less stable than O2.  O3 is looking for an opportunity to become O2 plus singlet oxygen (O). When this happens, singlet oxygen, O, combines with another singlet oxygen and forms O2 again. If no singlet oxygen is available, O combines with other surrounding molecules. This is called “oxidation,” and this form of cancer oxygen is particularly hard on cancer cells, killing some outright and stunting the growth of others. Ozone is administered rectally, intravenously and aurally (infusion into the ear canal allowing the ozone to absorb through the ear drum).

The 13 Major Effects of Cancer Oxygen Ozone on the Human Body – By Dr. Frank Shallenberger

Considered one of the leading authorities on medical ozone, Dr. Shallenberger has done important work to support the hypothesis that ozone can have long-term positive effects on AIDS. He has also conducted workshops on the proper application of medical ozone at an International Ozone Symposium in Texas. He successfully treats patients with medical ozone via Major Autohemotherapy. The thirteen physiological effects are list below and are accompanied by a brief explanation.

1. Ozone stimulates the production of white blood cells. These cells protect the body from viruses, bacteria, fungi and cancer. Deprived of oxygen, these cells malfunction. They fail to eliminate invaders and even turn against normal, healthy cells (allergic reactions). Ozone significantly raises the oxygen levels in the blood for long periods after ozone administration; as a result, allergies have a tendency to become desensitized.

2. Interferon levels are significantly increased. Interferons are globular proteins. Interferons orchestrate every aspect of the immune system. Some interferons are produced by cells infected by viruses. These interferons warn adjacent, healthy cells of the likelihood of infection; in turn, they are rendered no permissive host cells. In other words, they inhibit viral replication. Other interferons are produced in the muscles, connective tissue and by white blood cells. Levels of gamma interferon can be elevated 400-900% by ozone. This interferon is involved in the control of phagocytes’ cells that engulf and kill pathogens and abnormal cells. Interferon’s are FDA approved for the treatment of Chronic Hepatitis B and C, Genital Warts (caused by Papillomavirus, Hairy-cell Leukemia, Kaposi’s Sarcoma, Relapsing-Remitting Multiple Sclerosis and Chronic Granulomatous Disease. Interferon’s are currently in clinical trials for Throat Warts (caused by Papillomavirus), HIV infection, Chronic Myelogenous Leukemia Leukemia, Non-Hodgkin’s Lymphoma, Colon tumors, Kidney tumors, Bladder Cancer, Malignant Melanoma, Basal Cell Carcinoma and Leishmaniasis. While levels induced by ozone remain safe, interferon levels that are FDA approved (and in clinical trials) are extremely toxic.

3. Ozone stimulates the production of Tumor Necrosis Factor. TNF is produced by the body when a tumor is growing. The greater the mass of the tumor the more tumor necrosis factor is produced (up to a point). When a tumor has turned metastatic, cancer cells are breaking off and being carried away by the blood and lymph. This allows the tumor to take up residence elsewhere in the body; or in other words, divide its forces. These lone cancer cells have little chance of growing due to the TNF produced to inhibit the original tumor. When the tumor is removed surgically TNF levels drop dramatically and new tumors emerge from seemingly healthy tissue.

4. Ozone stimulates the secretion of IL-2. Interluekin-2 is one of the cornerstones of the immune system. It is secreted by T-helpers. In a process known as auto stimulation, the IL-2 then binds to a receptor on the T-helper and causes it to produce more IL-2. Its main duty is to induce lymphocytes to differentiate and proliferate, yielding more T-helpers, T-suppressors, cytotoxic T’s, T-delayed’s and T-memory cells.

5. Ozone kills most bacteria at low concentrations. The metabolism of most bacteria is on average one-seventeenth as efficient as our own. Because of this, most cannot afford to produce disposable anti-oxidant enzymes such as catalase. Very few types of bacteria can live in an environment composed of more than two percent ozone.

6. Ozone is effective against all types of fungi. This includes systemic Candida albicans, athletes foot, molds, mildews, yeasts and even mushrooms.

7. Ozone fights viruses in a variety of ways. As discussed above, ozone also goes after the viral particles directly. The part of the virus most sensitive to oxidation is the “reproductive structure”. This is how the virions enter the cell. With this structure inactivated, the virus is essentially “dead”. Cells already infected have a natural weakness to ozone. Due to the metabolic burden of the infection the cells can no longer produce the enzymes necessary to deal with the ozone and repair the cell.

8. Ozone is antineoplastic. This means that ozone inhibits the growth of new tissue because rapidly dividing cells shift their priorities away from producing the enzymes needed to protect themselves from the ozone. Cancer cells are rapidly dividing cells and are inhibited by ozone.

9. Ozone oxidizes arterial plaque. It breaks down the nnnn plaque involved in both Arteriosclerosis and Arthrosclerosis. This means ozone has a tendency to clear blockages of large and even smaller vessels. This allows for better tissue oxygenation in deficient organs.

10. Ozone increases the flexibility and elasticity of red blood cells. When one views a red blood cell under a microscope, it looks like a disc. In the capillaries, where they pick-up (lungs) and release (tissue) oxygen, these discs stretch out into the shape of an oval or umbrella. This aids their passage through the tiny vessels and makes the exchange of gas more efficient. The increase in flexibility of the RBC’s allows oxygen levels to stay elevated for days, even weeks after treatment with ozone.

11. Ozone accelerates the Citric Acid Cycle. Also known as the Kreb’s Cycle or TCA Cycle, this is a very important step in the glycolisis of carbohydrate for energy. This takes place in the mitochonria of the cell. Most of the energy stored in glucose (sugar) is converted in this pathway.

12. Ozone makes the anti-oxidant enzyme system more efficient.

13. Ozone degrades petrochemicals. These chemicals have a potential to place a great burden on the immune system. They also worsen and even cause allergies and are detrimental to your long-term health.

Ozone Oxygen Therapy for Cancer – Is It Safe?

1980 Jan – The German Medical Society for Ozone Therapy commissioned Marie Theresa Jacobs and Prof. Dr. Hergetbegan from the University Kilnikum Giessen and the Institute for Medical Statistics and Documentation of Giessen University to begin an inquiry entitled “Adverse Effects and Typical Complications In Ozone Therapy.” 2,815 questionnaires were sent out to all western German ozone therapists known by the Medical Society for Ozone Therapy (AGO, Arztliche Gesellschaft fur Ozontherapie).

1980 May – By now, The German Medical Society had collected 1,044 replies, or 37% of the total. The replies that were returned stated 384,775 patients were treated with ozone with a minimum of 5,579,238 applications.  The side effect rate observed was only .000005 per application. The report also stated “The majority of adverse effects were caused by ignorance about ozone therapy (operator error).”

Even with this report, there are still some opponents who warn Ozone Therapy is unsafe.  It is therefore wise to seek out an experienced ozone practitioner and to do further research into the pros and cons of this therapy.

How It Works

Cancer cells die when exposed to oxygen (cancer cells are anaerobic). There are many oxygen and ozone treatments, however, this article will discuss two of the best known and most effective “Stage IV” treatments – infusion bottle and ozone I.V.

Ozone therapy using an infusion bottle involves removing part of the blood from the body, saturating this blood with oxygen (i.e. ozone – O3), then putting this oxygen rich blood back into the body.

An ozone I.V. simply injects a fluid saturated with ozone into the blood. Both treatments work by getting oxygen into the body.

The Ozone RHP technique, which puts ozone gas directly into the bloodstream, is discussed in a separate article. (See link above)

Ozone Therapy

There are many different ways to get oxygen to the cancer cells using either Hydrogen Peroxide or Ozone. The Ozone treatments discussed herein must be administered by a medical practitioner.

In infusion bottle therapy: “a pint of blood is drawn from the patient and placed in an infusion bottle. The ozone is then forced into the bottle and mixed in by shaking gently, whereupon the blood turns bright cardinal red … The treated blood is then given back to the patient.”

There are very few cancer cells in the blood, for most types of cancer. In any case, it is the oxygen put back into the body that actually treats the cancer. It is very similar to an ozone I.V. except that the blood is being used as the fluid transport for the ozone. There are other benefits as well by using this treatment because of the high dose of ozone given to part of the blood.

Ozone treatments are generally given from twice a week to twice a day, depending on how advanced the disease is and other issues. Treatments can last for weeks or months.

Ozone I.V. is a similar treatment, except that no blood is extracted. An ozone saturated fluid is put into the bloodstream via I.V.

• “Ozone has been found to be an extremely safe medical therapy, free from side effects. In a 1980 study done by the German Medical Society for Ozone Therapy, 644 therapists were polled regarding their 384,775 patients, comprising a total of 5,579,238 ozone treatments administered. There were only 40 cases of side effects noted out of this number which represents the incredibly low rate of .000007%, and only four fatalities. Ozone has thus proven to be the safest medical therapy ever devised.” Considering that about 100,000 Americans a year die from drug reactions and interactions, ozone therapy is amazingly safe.”

Not all of these 384,775 patients were being treated for cancer, but no doubt there were a large number of cancer patients in the above statistics.

As might be suspected, these two treatments have been heavily persecuted around the world. It is not difficult, but not impossible, to find clinics which use these treatments.