(Cancer Care) Managing Cancer Pain: Key Considerations
Medical Supporter — Information Notice
This article is a summary of international medical information and is not medical advice; it cannot replace the diagnosis or treatment plan of your attending physician. The medical technologies, drug information and clinical data presented here are compiled from public literature and official statements of major Japanese medical institutions; the applicability and outcome of any therapy vary with each patient and must be assessed individually by a qualified physician.
- March 23, 2020
- 3 min read
1. What Is Cancer Pain?
Pain is one of the most common symptoms in cancer patients. It may arise from tumor compression, obstruction, or metastasis. Psychological responses to disease—including stress, depression, and anxiety—can further intensify pain perception.
2. Principles of Cancer Pain Management
The goal of cancer pain management is to provide continuous and effective analgesia with tolerable side effects to improve patient quality of life.
(1) WHO Three-Step Analgesic Ladder: Physicians select appropriate analgesics and adjuvants based on the intensity, location, and nature of pain:
- Mild cancer pain: Step 1 medications; begin with non-opioid analgesics.
- Moderate to severe cancer pain: Step 2 and Step 3 medications are required for adequate pain control, primarily opioid analgesics, sometimes combined with anticonvulsants, anxiolytics, antidepressants, antiepileptics, muscle relaxants, or corticosteroids. If pain persists or worsens, increase oral or injectable opioids or switch to equianalgesic transdermal patches as needed.
(2) Select the appropriate route of administration: Oral administration is preferred.
(3) Maintain correct dosing intervals: Regular, scheduled dosing maintains stable blood drug concentrations.
3. Common Analgesic Categories for Cancer Patients
(1) Non-opioid analgesics: Common agents include acetaminophen and NSAIDs such as celecoxib and naproxen. These are most effective for mild cancer pain and bone pain.
(2) Weak opioids: Codeine and tramadol relieve mild to moderate cancer pain.
(3) Strong opioids: For moderate to severe cancer pain, morphine is the preferred agent. Equianalgesic fentanyl transdermal patches may be used based on patient needs.
4. Common Side Effects and Management
These side effects are all treatable and preventable—patients should not avoid pain medication out of fear:
- (1) Gastrointestinal bleeding: Some non-opioid analgesics may cause GI bleeding. Concomitant use of gastroprotective agents is recommended.
- (2) Constipation: Common with opioid use. Prevent by increasing physical activity, hydration, intake of fiber-rich foods and vegetables, or regular use of stool softeners.
- (3) Nausea and vomiting: Typically occurs in early stages of opioid therapy and usually resolves. Prophylactic antiemetics may be prescribed as directed.
- (4) Drowsiness and respiratory slowing: Temporarily withhold the next opioid dose and monitor for symptom changes. If prolonged, the physician may reduce the dosage.
- (5) Psychological dependence: Addiction is extremely rare when opioids are used correctly according to medical instructions.
- (6) Allergic reactions: Skin itching and rash may occur; antihistamines can be used to relieve symptoms.
5. Daily Life Recommendations
- Take medications on schedule; do not stop on your own.
- Keep a daily pain diary documenting pain quality, location, frequency, and medications taken. Share this with your physician at follow-up appointments to find the optimal treatment plan.
- Constipation may occur with analgesics. Eat plenty of high-fiber vegetables and fruits, drink adequate fluids, exercise regularly, and use stool softeners as directed if necessary.
- Nausea, vomiting, or drowsiness may occur after analgesics. If symptoms persist or respiratory slowing develops, seek medical attention immediately.
- Non-pharmacological techniques may supplement pain relief, such as relaxation techniques, music therapy, and distraction activities like watching television.
Research shows that cancer patients with severe pain have a survival period approximately 44 months shorter than pain-free patients. Pain commonly impairs quality of life—poor appetite, disrupted sleep, and low energy reduce the body's capacity to fight cancer. Effective pain management is not only a quality-of-life measure but also a prognostic factor that can extend survival.
Electric Field Cancer Therapy (ECCT) — Cancer Adjuvant Treatment in Japan
ECCT is generally ineffective on normal cells because tumor cells have different electrical properties (conductivity and permittivity) than normal cells. Tumor cells have relatively higher electrical properties and are therefore more sensitive to external electric fields. The side effects of ECCT are minimal compared to chemotherapy, with no major adverse events reported.
The duration of ECCT treatment is determined by the physician based on clinical observation and ongoing assessment of treatment benefit.
A diet sufficient in albumin, vitamin C, flavonoids, and olive oil is recommended to support normal immune system function.
ECCT technology was developed by Professor Warsito P. Taruno and the CTech Laboratory team of Edward Technology (Indonesian Patent No. REGP00201200092, 2012).
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