The number 2 killer of Singaporeans is cancer.  While treatment for cancer (chemotherapy, radiation and hormonal therapy) has been improving rapidly through the years, many patients still die from cancer every year – and many of them suffer greatly from cancer pain.  For many, the most frightening part of having cancer is the threat of pain.  At Singapore PainCare Center, we help our cancer patients with difficult and refractory pain, improving their quality of life and restoring dignity to them in their time of need.  While the oncologist focus on treating and curing the cancer, patients can be confident that pain is treatable and manageable.

At Singapore PainCare Center, we are at the leading edge of cancer pain-relief technology. Having access to advanced equipment and up-to-the-minute techniques and medical procedures that allow our team of specialists to find the exact source of the pain and determine the best way to ease patients' suffering.

Pain can be related to the cancer itself or to the treatments needed to combat it. Causes of pain may include:

• A tumor may press on an organ, or expanding and stretching surrounding tissue
• Tiny cancer cells may get inside the bones and cause pain
• Sometimes a cancer nerve can spread pain wherever it travels in the body, making the patient hurt in places away from the cancer area (known as referred pain)
• Cancer treatment related pain:
1. Chemotherapy can cause numbness, tingling or pain - usually in the feet, legs or hands
2. Radiation DXT can cause affected areas to become inflammed
• Surgery to remove a tumor may itself be a cause of pain

Often doctors find pain hard to assess because it is highly subjective. That is, one patient may describe his or her pain as severe, while another experiencing the same degree of pain may describe it as mild.  Patients also tend to downplay the pain they experience when they visit their doctor because they are focused on what is happening at the moment, they do not want to seem like a complainer or because cultural differences come into play.  It is important that patients report all aspects of pain as honestly and fully as possible so that doctors can determine the best treatment methods.

Pain specialists take into consideration:

• Severity  -  Doctors commonly ask patients to rate pain on a 1 to 10 scale
• Time factors  -  How often, for how long and what time of day does pain occur
• Location  -  In one place or several, in a large area or small
• Quality  -  Stabbing, burning or crushing
• Modifying factors  -  Movement or activities that make the pain better or worse
  

MEDICATIONS: ORAL, PATCHES, SUBCUTANEOUS

In most cases, pain specialists follow what is called the "pain ladder" when planning treatments for cancer patients. The first rung on the ladder is analgesic medication such as Synflex, Voltaren, Celebrex or Arcoxia to stronger drugs known as Tramadol or Codeine. If these do not relieve the pain, still stronger medications containing morphine are given.  Some patients who do not like oral medication, there are sustained release morphine-like patches (Durogesic) that give good long-lasting relieve.  If even further relief is needed, the doctor goes up another rung on the ladder, which is to give higher doses of the strongest medications.  Unfortunately, some pain medications may cause certain patients to experience unpleasant side effects, like nausea, drowsiness and constipation.  Not infrequently, other non-pain killers can be effective in the treatment of cancer pain (eg. Lyrica, Amitriptyline, Lexapro and Alprazolam).

INTERVENTIONAL PAIN PROCEDURES:  NEUROLYSIS

Non-medicine treatments are sometimes added to the pain-relieving process. In certain types of cancer pain that are localized, chemicals may be introduced to the nervous supply of that area through minimally invasive techniques.  These medications block the pain and “burn-off” further painful nerves.  The effect can last from 6 months to 2 years.  The neurolysis procedures potentially can treat liver, stomach, pancreatic and colonic cancer pain.  Spinal pain and nerve pain within the chest arising from cancer invading the nerve can be treated successfully with this ablative procedure.

ADVANCED PAIN CONTROL:  INTRATHECAL DRUG DELIVERY

Some pain conditions can be very painful and refractory, eg cancer pain with bony metastasis, neuropathic pain secondary to cord myelopathy and many others.  In these cases, despite optimization with Morphine, the pain relief does not increase accordingly but yet the side effects escalate.  Patients develop distress and disappointment, progressing to depression and reduced quality of life. 

Most pain medication act on the spinal cord as this is where all the pain receptors are.  All oral medications after oral administration, undergoes metabolism, breakdown before it finally reaches the pain receptor in the spinal cord.

Intrathecal administration of drugs applies directly into the spinal cord.  This allows for reduced amount of medications needed to achieve the desired pain control without the associated side effects.

All of it goes into the pump that delivers a set amount of drug into the spinal cord.  This computerized pump deliver very exact amount of medication without fear of overdosing or underdosing.  Patient will return for refill of medication in the pump once in a couple of months.  This small pump will be implanted into the patient. 

Advantages of IT pump:

1. Better pain control with less medication
2. Increased survival compared with poorly controlled cancer pain
3. Less sedation effects with more clear headedness
4. Less side effects of medications (eg. Constipation, nausea)
5. Increased patient satisfaction
6. Less oral medication
7. No need for frequent follow up.

Patients before this treatment would be very disabled by the cancer pain, and distressed with concomitant sedation side effects.  After the implantation of this device, they would be able to go for holidays and enjoy their quality of life.