What You Need to Know to Manage Cancer-related Pain

Transcript Highlights
Dr. Brian M. Bruel
October 29, 2015

Welcome! Thank you for joining us today for “What You Need to Know to Manage Cancer-related Pain.” This Facebook chat is hosted by Dr. Brian M. Bruel and will cover topics such as:

– What are the types of cancer pain?

– In what ways does cancer cause pain?

– How are some of these things treated?

– What types of adjunct therapies are used to treat cancer pain?

And much more!

Brian M. Bruel, MD, is Assistant Professor, Department of Pain Medicine, Division of Anesthesiology and Critical Care, at the prestigious University of Texas MD Anderson Cancer Center in Houston, TX. Dr. Bruel has written extensively on the topic of pain and brings a wealth of knowledge to this topic.

More details on his background can be found at http://faculty.mdanderson.org/Brian_Bruel/Default.asp

Now, please join us in welcoming Dr. Bruel!

Dr. Bruel: Good evening and thank you for having me. I am a pain specialist with a particular interest in treating cancer-related pain. I am also the president-elect of the Cancer Pain Research Consortium. I am happy to answer questions you may have and provide some guidance. If you are experiencing pain related to cancer, you are not alone. There are many options to control pain and most of all, improve your quality of life.

Beth: What is breakthrough pain? Is this a temporary symptom of cancer?

Dr. Bruel: Breakthrough pain is when a person is taking medications on a schedule for pain control, but still has episodes of pain that “break through.” A lot of times this pain could be from activities or positioning. Sometimes a person can experience breakthrough pain even though they are not doing anything. This pain can be mild to severe. There are good strategies to help people who experience this.

PainPathways Magazine: Here’s Dr. Bruel’s article about Managing Cancer Pain.

T.Smallwood: Does breast cancer cause pain?

Dr. Bruel: Yes, breast cancer and the treatments for breast cancer can cause pain.

Phyllis:  Can my oncologist help me with pain, or do I need to find a pain physician?

Dr. Bruel: Your oncologist can help with your pain. Certain medications that oncologists give help with pain. Your radiation oncologist may also be helpful. Some radiation treatments are performed particularly for pain. The best way to manage pain from cancer is a team approach because many of the other disciplines provide some pain control options, not just the pain specialist. Pain specialists and palliative care doctors are experts in the use of medications for pain. Interventional pain specialists and even neurosurgeons can provide procedural options for pain control including nerve blocks or implantable devices for pain.

Smallwood: What factors, aside from chemotherapy and radiation, could cause pain to a person diagnosed with cancer?  Why are areas that contain tumors so warm? Does this hurt as a burn could?

Dr. Bruel: Musculoskeletal pain is a common problem. When a person has breast cancer, activities may be limited. Pain from joints and limbs from the mechanics could arise.

Tumors can cause a local inflammatory response that could feel warm. They are not the same as a burn.

King: Are there any types of alternative therapies that you would recommend for managing cancer pain?

Dr. Bruel: At our center we refer a lot of our patients to our colleagues at the Integrative Medicine department. They help with navigating through all the complementary and alternative therapies. Acupuncture may be helpful as well as biofeedback. Dietary strategies may also be useful for some. It would be a good idea to talk to your oncologist or pain specialist about herbs and supplements because these may harm or help you.

PainPathways Magazine: Read about two breast cancer survivor’s experiences living with residual pain.

Barby: Is there anything a cancer patient can do to prevent (or help prevent) post cancer neuropathy from developing?

Dr. Bruel: Discuss the symptoms you are experiencing with your treating oncologist because they will evaluate you for these toxicities and may provide other options. There is no literature looking at preventing the neuropathy, but there are a lot of treatment approaches once you have it.

Neuropathy after chemotherapy can be stubborn. There are multiple options to control this pain including medications, oral and topical. Procedures may be helpful, including neuromodulation. Neuromodulation is a way physicians can “block” pain using devices that deliver electricity or medications directly to nerve, spinal cord or brain targets.

Barby: I recently did stem cell therapy for RSD and ischemia. I was wondering if stem cells can be used to treat any forms of cancer?

Dr. Bruel: Stem cell transplantation is used to treat many forms of blood cancers. Stem cells for the treatment of pain have not yet been scientifically proven and validated in big studies, but we are looking into the current research with optimism.

Barby: Thank you, I am 10 days out and seeing dramatic improvements with ischemia (cardiac and intestine) as well as with my RSD. I look forward to seeing more patients benefit from it… so glad to know that it is used in blood cancer treatment with success as well.‬

Kathy: I have been diagnosed with fibromyalgia (post chemo)…what are some good ways to deal with auto-immune responses post chemotherapy? I was a very active person prior to my cancer diagnosis in 2013 but systemic pain and fatigue have made my recovery difficult. I’d love to return to an active lifestyle but pain has made that difficult. Standard protocols of treatment are not helping. Suggestions?

Dr. Bruel: First of all, I want to say that you are not alone. Many patients complain of fibromyalgia syndromes after their treatments. I typically approach this using a multi-modality approach. First, I encourage getting back into an active lifestyle as you tolerate it. Maybe consider doing aquatic type exercises since this is not so hard on your joints. Other approaches include many of the medications that would help fibromyalgia. I really try to keep my patients as functional as possible using these simple approaches.

Doug: Is there a level of post cancer pain that I should expect? When do I know that I need to reach out to a pain specialist?

Dr. Bruel: At least 50% of patients with cancer will experience some type of pain. You should discuss your pain symptoms with your oncologist. If the pain is limiting your quality of life, mobility and even preventing you from proceeding with the cancer treatments it may be a good idea to seek the help of a pain specialist. Oncologist may be able to help with medications, but if this is not enough, a pain specialist may be able to offer other modalities such as nerve blocks.

Kimberly: I am a nurse. I see patients dealing with pain from cancer and other illnesses but they don’t want to take pain meds because they are afraid to get hooked, they say. Any suggestions for helping them?

Dr. Bruel: Thank you for what you do. I encounter this all the time as well. Pain medications have been demonized lately and it is unfortunate for the patients with cancer who would actually benefit. Education about why they were prescribed these medications is important. Education about addiction and dependence is also helpful. Once they understand this, they may be more open to using the medications for their pain. I often tell them that they do not have to suffer through these treatments. A lot of times I recruit the help of our clinical psychologist and social workers to help me understand my patients’ fears in more detail.

PainPathways Magazine: This article sheds light on women and cancer pain.

Gresham: Is pain from cancer treatment considered “cancer pain”? How is that treated?

Dr. Bruel: I classify this as cancer-related pain. Fortunately we now see a lot of people who are long term survivors of cancer. Unfortunately, they may experience long term chronic pain due to to the treatments, such as post-surgical or radiation syndromes. Even though these syndromes become chronic, they are still cancer-related.

Allison: I suffer from chronic neuroma pain after receiving a successful DIEP reconstruction surgery after mastectomy and treatments. I have unsuccessfully dealt with the pain for the past 2 years. My body responds with high blood pressure, uncontrollable tremoring and sweating. I often vomit from the unrelenting stabbing pain. These symptoms have increased over the past two years and have now lead to poor overall health. I have been to several specialists, from Tulane to Johns Hopkins. Neuroma surgery is a last ditch option, as the neuroma is located in radiated damaged scar tissue in the axillary area.

I’m currently under the care of a great pain management doctor who has tried to get all symptoms under control by doing nerve blocks, opiate control, and other meds to control the other reactive side effects of the severe pain. However, he is losing faith that anything other than removing the entire “breast” will give me a quality of life outside of my house, doctor offices, and hospitals. The thought of another surgery, especially one that is not sure to “fix” the problem, worries me. However, I haven’t fought this long to live this kind of life, either. This isn’t really a question, but merely a way of venting on behalf of those whose lives have been forever changed by cancer. Thanks for providing this platform.

Dr. Bruel: Thank you for sharing your experience. I am sorry to hear you are suffering this much. It seems that your pain team and oncology team have really thought long and hard about the options. I want to reiterate that the best way to treat pain related to cancer is typically a team approach, including the expertise of the oncologist, radiation oncologist and pain specialists. I hope that you will get some relief.

Lynn: What are the types of cancer pain?

Dr. Bruel: Pain from cancer can be caused by the tumor or disease process itself. Pain may also be a result of the treatments for cancer, including syndromes after surgery, chemotherapy or radiation.

Anonymous: Is there a way to help someone diagnosed with terminal cancer?

Dr. Bruel: Definitely many ways to help. It is devastating news to be diagnosed with terminal cancer and much of the initial approach is to help the patient accept this. It is also important that the patient does not feel alone and that there are many ways to help reduce suffering at the end of life. Palliative care specialists are important team members to help ease the suffering of these patients and their family.

Sparks: My pain seems to be increasing. How do I tell my doctor without sounding like a “seeker”?

Dr. Bruel: Tell your doctor the truth. Try to describe your symptoms as accurately as you can. Physicians are here to help you and rely on relationships and trust with our patients. We are also concerned about the safety of our patients and our community.

PainPathways Magazine: In search of a pain specialist?  Try this pain specialist locator.

Morgan: Hello, is there a difference between cancer pain management, palliative care, and hospice? If so, what are the differences?

Dr. Bruel: Cancer pain management is typically a pain specialist who can provide pain control using medications and procedures. They treat patients comprehensively, which may include rehabilitation therapies and psychologic approaches. Palliative Care Specialist are doctors who also provide many of the above treatments, except procedural care. Palliative care specialists also address other symptoms such as fatigue, shortness of breath, anxiety, fear, end of life existential concerns, spirituality. Hospice care addresses many of the things palliative specialists do closer to the end of life.

PainPathways Magazine: Informative article on pelvic pain and other signs of gynecological cancer!

PainPathways Magazine: Hi everyone! This is Amy North, editor of PainPathways. On behalf of the magazine, we’d like to thank our expert and all those who participated in tonight’s chat! We are excited to be offering this great forum for information and inspiration.

Have a good night everyone!


Professional and individual subscriptions to
PainPathways Magazine
are available at www.PainPathways Magazine.org.

All information provided is for educational purposes only. Neither PainPathways Magazine nor their Facebook Chat hosts are responsible for a medical diagnosis. Individuals should seek a physician for evaluation and personalized treatment plan.