Tumor Pain Management

Tumor pain therapy is a very important area of pain medicine or anesthesiology. Tumor pain therapy is the sum of therapeutic measures that result in a reduction of tumor-related pain. Especially the chronic character of this pain is a special challenge and should be treated in an interdisciplinary way by considering not only the physical causes but also psychological and psychosomatic aspects. Tumor pain mainly affects patients whose disease has reached an advanced stage, so that curative treatment is usually not the focus of therapy. In this case, patients are primarily treated palliatively. Thus, from a palliative point of view, tumor pain therapy focuses on maintaining or improving the quality of life of the individual.

Tumor Pain

In pain analysis, two types of tumor pain can be distinguished. Nociceptive pain is caused by tumor or metastasis growth or by the accompanying inflammatory response of the surrounding tissue. Depending on the localization, this pain can be divided into somatic pain, i.e., originating from joints, bones, or muscles, and visceral pain, originating from internal organs. Neuropathic pain, on the other hand, results from direct damage to nerve tissue due to arrosion (gnawing) by the tumor. This may even result in severing of nerve pathways.

Approaches to pain management

Tumor pain therapy is divided into several areas. First and foremost is drug pain therapy, which are defined according to the WHO 3-stage regimen. This drug-based pain therapy is based on a gradual intensification of pain therapy as symptoms progress (progress). In addition, so-called adjuvants (auxiliary substances) are used to support or increase the effect of the pain medication. These include, for example, antidepressants and anticonvulsants (drugs for depression or increased convulsiveness). Furthermore, it is often necessary to reduce the side effects of the medication to be taken. For example, opioids often cause nausea, and for this reason antiemetics (medications against nausea or vomiting) are used. Laxatives (laxatives) that counteract opioid-induced constipation (constipation) are also used. The success of drug therapy for pain must be monitored closely, e.g., by means of pain scales. Regular intake of the medication ensures a constant blood plasma level and thus a sufficient (adequate) therapy. Patients and their relatives must be informed about the side effects, especially since it is a long-term intake.

WHO 3-stage regimen

Tumor pain: use of level 2 opioids or alternatively low-dose level 3 opioids for mild to moderate pain or inadequate symptom control with non-opioid analgesics. Respiratory distress: use of oral or parenteral opioids; these are considered first-line drugs for symptomatic relief of respiratory distress. Other aspects of tumor pain management include early psychological and behavioral treatment of patients. Emotional and psychological distress is often an important factor in tumor pain therapy and requires the intervention of a psychiatrist or psychotherapist. Coping is a term used to describe the coping strategies that a patient must develop. This often requires professional support in light of the patient’s palliative situation.

Other procedures

Non(-pain) drug-based tumor pain therapy.

  • Antibiotics – Adequate treatment of concomitant infections, e.g., skin and soft tissue metastases.
  • Irradiation – Initially increase in pain, but in the course of considerable pain reduction is possible.
  • Chemotherapy / hormone therapy – Here, pain reduction is also possible, usually these therapies pursue a curative approach, but palliative use is also possible.

Interventional tumor pain therapy