Controlling Pain During Pancreatic Cancer Treatment

Aggressive cancers like pancreatic adenocarcinoma require aggressive treatment, a daunting prospect for any newly diagnosed patient.

In addition to dealing with the potential side effects of radiation, chemotherapy, or surgery, many patients also experience pain, often in the abdomen or lower back. While many assume this is just an unfortunate part of the bad hand they’ve been dealt, Michael Erdek, Jr., M.D., would like patients to know that it doesn’t have to be. The director of pain management at the Northwell Health Cancer Institute is on a mission to help alleviate the pain associated with cancer.

Whether it’s a prescription for painkillers or one of many treatments that work more directly on the nervous system, patients have more options than ever to manage cancer-related pain. “While you are going through your primary cancer treatments, know that there are people who are specially trained and dedicated to treating your pain too,” Erdek says. “And nothing we do in our sphere will negatively impact your primary cancer treatment.”

Growing Menu of Options

For most pancreatic cancer patients, their pain can be effectively managed by painkillers. Although stories of the opioid epidemic may make some patients wary, Erdek says they should not be afraid of pain medications, especially when administered as part of a carefully controlled treatment plan. “The fact is, some 80 percent of cancer pain can be relatively well managed by oncologists using pain medications,” he explains.

The remaining 20 percent of cancer pain can be difficult to treat using standard approaches. The medications may no longer be effective, or the side effects at high doses are not well tolerated. In some rare cases, the high doses have the paradoxical effect of increasing the pain they are prescribed to ameliorate, a phenomenon known as opioid-induced hyperalgesia.

For those patients, there is hope in the form of therapies that work directly on the nervous system to provide significant relief. Available at Northwell Health and other specialist pain centers, these include:

• A nerve block is a procedure performed by an anesthesiologist that targets the nerves that are transmitting the pain. A numbing medication (a local anesthetic) is placed around a nerve or group of nerves that relay sensations from a certain body part to the brain—the epidurals used on women in labor would be an example in a non-cancer setting. 

• Pain specialists can also deliver medications directly into the central nervous system, which allows them to give higher doses while avoiding a lot of the side effects you’d get if you took the same drugs orally or intravenously. Intraspinal pumps can be connected via catheters or implanted devices to deliver constant infusions of pain medicine.

• Yet another approach is to place electrodes in the spinal canal or near specific nerves to block pain signals to the brain.

The best approach for one patient might not be appropriate for another, so strategies should be tailored to each individual. That’s the goal of Erdek and his team. “We’re all wired a little differently. Everyone has different ways they experience and tolerate pain. There are so many different factors that integrate into the recommendations we give,” he adds.

A Team Game

Pain specialists can be involved at any stage in the patient’s cancer journey. Nerve blocks might help some patients be more comfortable during radiotherapy treatments, for instance, while others may want to adjust their pain management strategies after treatment.

Patients curious about their options should talk to their oncologist or the palliative care team, who are particularly well-trained in the nuances of opioid management. Palliative care specialists can evaluate a patient’s unique needs and physical conditions, including any co-morbidities like diabetes or heart conditions. They will consider liver and kidney function, as well as blood coagulation status and other biomarkers. The palliative care team also takes into account the particulars of the chemotherapy drugs or any other medications you are taking.

Other key members of the team include family or members of the patient’s immediate support network. Their insights into their loved one’s experiences can help inform the best strategy. They can also be an advocate if the patient does not feel comfortable talking about the issue.

Erdek is a big proponent of including a large network of specialists, support workers, and the patient’s family in order to make the experience as comfortable as possible. “You are not alone,” he emphasizes. “There is hope, and there are so many people who are invested in your welfare.”