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Medical therapies for pain
Sometimes medicines or physical, psychological or complementary methods cannot relieve severe pain related to cancer. More aggressive or invasive methods may be needed.
Different types of surgery may be used to help manage severe pain. Removing as much of a tumour as possible is called debulking. Reducing the size of a tumour can relieve pain by lowering the pressure on nearby tissues, structures or organs.
In serious cases, surgery may be used to cut nerves, often near the spinal cord. Cutting the nerves interrupts the pathways that take pain signals to the brain. This surgery is only done in certain cases and when other methods of pain control do not work.
Surgery may be used to fix (stabilize) bones in the spine so the person doesn’t have pain when they move. Surgery may also be used to prevent complications from a tumour or its treatment, such as a blocked bowel.
A nerve block is a procedure in which the doctor injects drugs into or around a nerve or into the space around the spinal cord. The drugs used are a local anesthetic and medicine to block pain, such as an alcohol, steroid or opioid. The drugs block pain by destroying nerve tissue or blocking pain signals so they cannot reach the brain.
Nerve blocks can help if the pain can be traced to one damaged nerve. How a nerve block is done, as well as the risks and benefits of the procedure, will depend on where the nerve is located.
Neurostimulators are devices that can be permanently placed in the body. These devices send electrical impulses that block pain signals from nerves so they cannot reach the brain. Neurostimulators are used in certain cases to treat chronic back or leg pain that does not respond to other pain control methods.
Radiation therapy uses high-energy rays or particles to destroy cancer cells. It can relieve pain by shrinking a tumour that is pressing on nerves, organs or the spinal cord. Radiation therapy can also be used to reduce pain by treating cancer that has spread to the bone, which is called bone metastases. Sometimes only a few doses of radiation are needed to ease pain.
External beam radiation therapy is most commonly used to relieve pain. Stereotactic radiation therapy may be used to direct radiation therapy to very specific areas, such as a tumour in or near the spine or around areas that have already been given radiation.
Chemotherapy uses anticancer (cytotoxic) drugs to prevent cancer cells from growing and spreading. It may be used to shrink a tumour to reduce pain.
Hormonal therapy changes hormone levels in the body to slow the growth and spread of cancer cells. It may be used to relieve pain by shrinking a hormone-dependent tumour, such as breast or prostate cancer.
Cancer that spreads to the bones often causes pain and can make the bones weak and more likely to break. Cementoplasty uses cement to fill parts of a bone that have been damaged by cancer. It can be used to make the bone more stable and so reduce pain. For example, bone cement may be injected into damaged vertebrae, which are the bones of the spinal column that support and protect the spinal cord. Strengthening the vertebrae can ease pain and help support the spine.