Pancreatic Cancer: Symptoms of Pain
The pancreas lies in close proximity to many other organs of the digestive system such as the small intestines, the liver and the stomach. It has a network of nerve fibers that interact with the autonomic nervous system which acts as the control of many involuntary functions of the body such as waste elimination, sweating and beating of the heart.
Cancer of the pancreas is often detected late because of the lack of early signs and symptoms. Even if it is detected at an early stage prognosis is often poor because it spreads rapidly to other organs. Because of this pancreatic malignancy is one of the leading causes of death due to cancer.
The most dreaded symptom of cancer is severe pain. In pancreatic cancer symptoms of pain may consist of:
- Mid-upper abdominal discomfort to severe pain due to the tumor of the head part of the pancreas
- Left upper abdominal discomfort to severe pain due to the tumor of the tail end of the pancreas
- Poorly localized abdominal cramps which may be a sign of intestinal obstruction
- Right upper abdominal pain signifying spread to the liver
- Referred pain to the shoulder, neck and back
- Pains are often progressively worsening
- Pains may be accompanied by insomnia, anxiety, depression, fatigue, nausea and constipation
Pancreatic Cancer Pain Relief
Cancer pain relief is one of the best ways to help a patient in any stage of the malignancy, especially in advanced stages when prognosis is poor. The choice of treatment of pain will depend on its severity and the patient’s response.
Many cancer patients with mild to moderate pain respond to oral medications consisting of potent nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen. However, with chronic and progressive pain round-the-clock intake of these drugs may result in complications like abdominal discomfort, gastric bleeding and nausea. Oral pain medications will then be supplemented or replaced with opioid or narcotic drugs whose dose and frequency will be determined by the quality of pain. Adjuvant drugs such as antidepressants, anticonvulsants and corticosteroids may also be given to modify the patient’s response to pain. It is important to note that in patients who are suffering advanced forms of cancer with severe pain drug addiction is not a major concern since relief of depression and ability to carry on normal daily activities are important in maintaining their quality of life.
When oral pain medications are no longer able to relieve pain for long periods of time without giving large doses, other options available are:
- Transdermal fentanyl patches – opioid patches that are applied on the skin which absorbs the drug slowly. Except for constipation, the patient becomes tolerant of side effects like respiratory depression, nausea and sedation.
- Percutaneous celiac plexus blockage – involves nerve destruction around the tumor by needle injection of alcohol through the skin while being guided by imaging procedures. Effective pain relief is obtained at wide ranges of time with this technique.
- Celiac nerve blockade with endoscopic ultrasonography – similar to the percutaneous technique but assisted with ultrasonography
- Radiation therapy – can decrease tumor size and decrease pain
- Chemotherapy – helps reduce the spread of cancer cells and may relieve pain although it has many unpleasant side effects like nausea, vomiting, fatigue and hair loss
- Narcotic injection around the spinal cord (intrathecal or epidural) using pain pumps that may be controlled by the caregiver or the patient himself – provides round-the-clock pain relief
These options for pancreatic cancer pain relief may be used in combination for better results and at the same time decreasing the risk for complications or side effects of each. Cancer pain is the most common symptom that is dreaded by cancer patients and yet it is one that is most treatable. Cancer pain relief is important especially in those who have poor chances for survival since an improvement in the quality of life may mean more meaningful time for relationships, work and personal fulfillment.
Medscape, “Palliative Care in Pancreatic Cancer: Pain", https://www.medscape.com/viewarticle/468138_7
USC Center for Pancreatic and Biliary Diseases, “Pain Management", https://www.surgery.usc.edu/divisions/tumor/PancreasDiseases/web%20pages/general/pain%20management.html