Cancer Pain? No One Has to Suffer

Written by: Kamlesh Sisodiya, M.D.

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About 75% of all cancer pain patients with advanced and spreading cancer report having pain. Fortunately, the pain in 70-90% of these patients is controlled with medication taken by mouth or intravenously. However, 10-30% of patients with cancer, have intractable pain. They do not need to suffer unrelieved pain. Now there are more sophisticated interventional approaches to relieve this kind of pain. These are certainly high-tech approaches and they do wonders for pain control.

Physicians who specialize in interventional pain therapy work closely with the referring physician in treating the patients’ pain using a wide variety of pain treatments including this high-tech method of placing the medicines in the area around the spinal cord, not in the spinal cord itself.

The introduction of new technologies and medical devices in the 1990’s has provided a very efficacious option these days. Various spinal devices involving delivery of medication externally through the skin to epidural or spinal areas provide good pain relief for patients with very limited life expectancy.

However, patients with a life expectancy of three to six months or longer may benefit most from a fully implantable, programmable intrathecal drug infusion system. This system became available in early 1980’s for intrathecal administration of morphine for intractable cancer pain. The beauty lies in that only 1/100th the dose of morphine can provide effective analgesia compared to that required by intravenous administration. With such small doses, side effects are usually minimal. Other advantages of the fully implantable drug infusion system include freedom from having multiple attachments, less refills, dosage adjustment with computing device externally, and variable drug dosage scheduling throughout the day.

The cost of the device and implantation may be a bit high initially,but it is offset over time due to low maintenance and drug cost. Of all implanted systems, it is less than the cost of a system with an external pump as early as four months postimplant.

Dr. Kamlesh Sisodiya is an anesthesiologist, pain medicine specialist. He recently joined the staff of the Texas Institute of Pain Medicine &Advanced Pain Care. He previously completed his fellowship in pain management from the University of South Carolina at Richmond Memorial Hospital.

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