Sometimes pain can be difficult to relieve completely with medications. This may be the case both for people with cancer and for those who have responded well to cancer treatment and are in remission. In these situations, your doctor may suggest you go to a pain medicine specialist in a multidisciplinary pain clinic.
Epidural or spinal medication
Sometimes, to control pain, morphine needs to be used in such high doses that severe side effects occur. Delivering the morphine directly onto the nerves in the spine via a tube (catheter) can give good pain relief with fewer side effects. Other drugs can also be added to improve pain control. Spinal medication can be given in a number of ways:
- Tunnelled epidural catheter – A small tube put in the space around the spinal cord and then tunnelled out to the body’s surface through the skin. It is attached to an external syringe pump, which delivers the medication (e.g. anaesthetic and/or opioid). Medication may be delivered in a single dose, as a continuous infusion, or using a combination of these methods.
- Port-a-cath spinal system – Similar to the tunnelled catheter, but medication is delivered through an opening (port) that is attached to the tube under the skin of the chest or abdomen.
- Intrathecal catheter and pump – Implanted in the fatty tissue of the abdominal area. The pump is refilled every three months with a needle through the skin into the pump’s port.
When certain substances are injected into or around a nerve, that nerve is no longer able to send (transmit) pain messages. This is called a nerve block. Sometimes nerves to part of the bowel or pancreas can be blocked to give pain relief, especially in pancreatic cancer. This is called a coeliac plexus block.
Other pain-relief methods
Your specialist may suggest one or more of the following options:
- intensive cognitive behavioural therapy (CBT) – guides people to positively change the way they cope with their pain and to resume normal activity as much as possible
- desensitisation – a technique that involves focusing on the pain but relaxing at the same time, used for neuropathic pain (e.g. numbness, tingling or burning)
- specialised physiotherapy – helps reprogram the brain (e.g. dealing with phantom limb pain after an amputation)
- radiofrequency treatment – uses heat to destroy the nerves that are causing pain, and is used for back and neck pain due to osteoarthritis (breakdown of cartilage between joints)
- neuromodulation treatments – change nerve activity through electrical pulses that cause the body to release a substance that stops feelings of pain relating to nerve damage (e.g. after surgery, chemotherapy or radiotherapy, and for non-cancer causes)
- surgery on the brain or spinal cord – in rare cases, neurosurgery can be done to help relieve pain.