Pain is scary – especially for cancer patients who don’t know whether the pain will ever go away, said MUSC Hollings Cancer Center patient Julie Jablin.
Jablin has stage 4 lung cancer, and for a time, the pain was so intense that she was on morphine. That changed when she was referred to Thor Johnson, M.D., Ph.D., a diagnostic and interventional radiologist who specializes in pain management.
Through a variety of interventional techniques, including radiofrequency ablation, kyphoplasty and nerve blocks, he was able to get her pain under control – which in turn recently enabled her to enjoy a two-week trip to Scotland and England to attend the wedding of a former exchange student.
“That was great. We had not seen her in a while, and she’s from Germany, so her whole family from Germany was there. We got to meet them all, and that was fabulous,” she said.
“But you know, you can’t do that if you’re so wiped out on morphine that you can’t function and you can’t enjoy yourself,” Jablin continued. “One of the things that Dr. Johnson was able to do was to get me to the point where I could get out. And I did get out. You know, I walk a lot. I go to the gym. I’m living a fairly normal life at this point, which is such a blessing. It’s such a gift. It really is.”
Julie Jablin explored Scotland and England while traveling for her former exchange student's wedding. Photo provided
Johnson and Jablin came together recently for an episode of Hollings Cross Talk to discuss the latest options for pain control in cancer patients.
About 30% of cancer patients have pain that isn’t being controlled, Johnson said.
“That’s terrible, right? I mean, it’s great that we’re developing all these new treatments to try to make their cancer better. But if you don’t also deal with quality of life in these patients, then I feel like you’re not really doing them much of a favor,” he said.
Some types of pain, including neuropathy, don’t respond well to opioids, he said. Neuropathy is a common side effect of some cancer treatments; it’s caused by damage to peripheral nerves and can lead to sensations ranging from tingling to a burning feeling.
Even when dealing with types of pain that do respond to opioids, doctors need to consider the potential side effects – for instance, the fact that the majority of cancer patients taking opioids end up with opioid-induced constipation.
Johnson performed several procedures for Jablin, such as a radiofrequency ablation, which uses heat generated from electricity to destroy selected nerves and tumors, in some cases, so nerves will stop sending pain signals and tumors stop pressing or irritating adjacent nerves. Also kyphoplasty, which treats small bone fractures by injecting them with a special cement; in Jablin’s case, the cancer had eaten away at the acromion, the tip of her shoulder blade, which was causing a great deal of pain. Finally, he performed several nerve blocks. The process wasn’t completed overnight, Jablin said, but took place over multiple visits. Johnson said it can take time to determine which nerve cluster is sending the pain signals.
Dr. Thor Johnson said that 30% of cancer patients have pain that isn't controlled. Photo by Kelsey Hudnall
“There’s always a little bit of diagnosis in the treatment of cancer pain in this circumstance,” Johnson explained. “To some extent, you must go through the steps to figure out what exactly is the source of the pain and then how to treat that. It can be frustrating, I think, for patients sometimes, but it does require a little bit of a process to get to what it is that’s going to fix them.”
Being treated at a National Cancer Institute-designated cancer center with an emphasis on multidisciplinary care is part of the equation. Johnson sits on several Hollings tumor boards, and he said the collaborative back-and-forth between the different specialists as they form treatment plans contributes to patient care and to doctors’ awareness of the various options.
Still, there’s a way to go in ensuring that cancer patients get the same level of pain management as chronic pain patients, he said. Part of that is due to how the pain shows up. Pain is predictable for a patient who’s suffered a trauma, he said. But pain from cancer can pop up unexpectedly. The key is translating existing pain management offerings in a way that makes sense for cancer patients while also being aware of how interventions might affect their other medications, Johnson said.
Julie Jablin said it's important for patients to speak up when they're in pain. Photo provided
Johnson and Jablin both said that communication is critical.
“It’s the patient as partner, to be honest. They have to trust you, and you have to trust them. And you need to have an ongoing dialogue,” Johnson said.
Jablin said patients need to be willing to speak up.
“I know for me, it’s difficult at times to call the doctor and say, ‘I have pain; I need to be treated,’” she explained. “Because you almost feel like a failure.”
Jablin said she had a tendency to feel like she wasn’t doing something she should have been, and that’s why she had pain.
“You must get past that. And you have to call up, and you have to say, ‘Look, I have pain. I need some help with this,’” she said.
Original source can be found here.
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