Cancer pain

What is it?

Cancer pain is pain that arises secondary to cancer or as a result of its treatment. It encompasses all types of pain and can be acute or chronic.

The referral pathway

Most specialist cancer pain referrals are made by our colleagues in palliative medicine or oncology. These are often made via the palliative care multidisciplinary team meeting that we attend or via direct contact with Dr Titterington or Dr Black, who are our cancer pain specialists.

What we offer

Assessments

Patients who are referred to our service are seen and assessed by one of our Pain Management Consultants. A typical assessment will cover several core areas:

History of pain and its effect on function, wellbeing and quality of life
General medical history
Investigations, treatments and interventions already received for cancer
Medication history
Prognosis and outlook

Following this an individualised plan will be made on how to proceed and may include:

Advice
Medication changes
Interventions
Further investigations
Referral to another specialist or centre

The outcome of this will be explained during the consultation and will be documented in the medical records. A copy of the clinic record will be sent to the GP.

We also offer specialist advice to colleagues in Palliative Medicine and Oncology and attend regular multidisciplinary team meetings.

Interventions

We offer a range of interventions from simple injections through to complex implantable devices, such a spinal cord stimulators and intrathecal pumps. Our choice of intervention and/or injection will follow national guidance and commissioning pathways and will be individualised to each patient based on the nature and cause of their pain, prognosis, medical comorbidities and potential risks.

Here is a list of some of the common interventions we offer:

Simple spinal injections
Ultrasound guided nerve block
Thermal radiofrequency denervation
Pulsed radiofrequency treatment
Sympathetic nerve block of stellate ganglion or coeliac plexus, lumbar plexus or ganglion impar block
Neurolytic injections
Neuromodulation – spinal and peripheral
Intrathecal drug delivery systems
Qutenza

This list is not exhaustive and many more interventions are available.

Patient information leaflets on many of these procedures are available from the Faculty of Pain Medicine website.

Intrathecal pumps offer a mechanism of delivering pain relief directly into the intrathecal space which is located around the spinal cord. This allows the delivery of strong analgesia in smaller amounts and also local anaesthetic to numb painful areas. The intrathecal pump consists of a plastic catheter connecting the spinal space to a drug reservoir and programmable pump which is surgically implanted in the abdomen. These pumps have the ability to provide background infusions and also bolus doses for breakthrough analgesia.

A spinal cord stimulator is a medical device which is used to treat severe nerve pain. It consists of a small battery pack which is surgically inserted beneath the skin and is connected to a lead placed near the spinal cord. The battery sends electric signals to the lead in the epidural space next to the spinal cord, altering the longstanding pain signals, often reducing the perception of pain and subsequently improving a patient’s quality of life.

Historically spinal cord stimulators used a system which caused tingling in the painful area often helping to mask some of the pain, but this is no longer necessary as many newer systems are free of the tingling sensation. As the science has evolved, so has technology, and many systems have long-lasting batteries or ones that can be recharged. There are several reputable medical companies who produce spinal cord stimulators. The most appropriate will be selected for everyone treated by the PAIN Team at Leeds.