Experiencing pain may increase the odds that cancer survivors will use cigarettes and cannabis, according to a recent study published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society. The study also found that cigarette smoking and pain are linked to more treatment-related side effects and worse health among cancer survivors.
Pain and use of cigarettes, e-cigarettes, alcohol, and cannabis commonly occur together in the general population. To characterise pain in relation to such non-opioid substance use specifically among cancer survivors (who often experience pain), investigators analysed data from two national samples of individuals with a past diagnosis of cancer in the United States: 1252 adults from Wave 6 (2021) of the Population Assessment of Tobacco and Health (PATH) Study and 4130 adults from the 2020 National Health Interview Survey.
PATH data indicated that higher past-week pain intensity was associated with a greater likelihood that cancer survivors would use cigarettes, e-cigarettes, and cannabis, and a lower likelihood that they would drink alcohol. National Health Interview Survey data indicated that chronic pain was associated with a greater likelihood of cigarette smoking and a lower likelihood of alcohol use. In both studies, cigarette smoking and pain were linked to fatigue, sleep difficulties, poorer mental/physical health, and lower quality of life.
“These findings show that because pain and substance use are interconnected among cancer survivors, it’s important to focus on treating both together in cancer care. Pain can drive substance use, and substance use can worsen pain, creating a cycle that’s hard to break,” said lead author Jessica M. Powers, PhD, of Northwestern University’s Feinberg School of Medicine. “While cancer survivors might smoke cigarettes or use substances to get immediate relief from their pain and cope with other symptoms, this can be incredibly harmful for their health by reducing the effectiveness of cancer treatments and increasing risk for cancer recurrence.”
SCP – Dr Winter performing a CT-guided interventional procedure
World Cancer Day, observed every 4 February, aims to raise awareness about cancer, encourage prevention and look at ways of improving a cancer patient’s quality of life. Interventional radiology plays a significant role in pain management for cancer patients.
Traditionally, radiology was used for diagnosing the cause of the pain but interventional radiology has changed this paradigm. Since American radiologist Charles Dotter, first used a guidewire and catheter to perform an interventional procedure in 1964, radiologists have become actively involved in intervention, including interventions for pain management. Today, many minimally invasive procedures are routinely performed in busy radiology departments.
Dr Arthur Winter, a radiologist at SCP Radiology says, ‘Interventional radiology has developed rapidly. Pain management procedures are becoming a daily part of busy radiology departments and play a crucial role in managing pain for cancer patients.
‘Cancer-related pain can be a significant burden, affecting patients’ quality of life and hindering their ability to carry out daily activities,’ says Dr Winter. ‘Radiology offers various techniques and treatments that help alleviate this pain effectively. These therapeutic interventions in pain management include image-guided interventional radiology procedures and radiation therapy.’
Understanding pain
Pain is a signal from the nervous system to let you know that something is wrong in your body. It is transmitted in a complex interaction between specialised nerves, the spinal cord and the brain. It can take many forms, be localised to one part of the body or appear to be widespread.
The nature of cancer pain
Cancer pain can arise from multiple sources, including the tumour itself, which may invade or compress surrounding tissues, organs or nerves. Metastases, the spread of cancer to other parts of the body, can also cause significant pain. Additionally, pain can result from the treatment of cancer, such as chemotherapy and radiation therapy.
Multidisciplinary approach to pain management
Effective pain management for cancer patients requires a comprehensive, multidisciplinary approach. Oncologists, radiologists, pain specialists and other healthcare providers collaborate to develop individualised care plans. Radiology is essential in both the diagnostic and therapeutic phases of this process, providing crucial insights and treatment options.
These personalised care plans, tailored to each patient’s needs, ensure:
Accurate diagnosis and identification of pain source or sources
Targeted and effective treatment interventions
Ongoing monitoring and adjustment of pain management strategies
Imaging techniques
Diagnostic radiology initially uses various imaging techniques to identify the source and extent of pain in cancer patients. These techniques include: X-rays, CT scans, MRI, PET scans and ultrasound.
By identifying the precise location and cause of pain, radiology can help:
Determine the most appropriate interventions, such as surgery, radiation therapy or minimally invasive interventional procedures
Monitor the effectiveness of pain management strategies and make necessary adjustments
Avoid unnecessary treatments that may not address the underlying cause of pain
Interventional radiology
Interventional radiology uses minimally invasive techniques to diagnose and treat various conditions and, for cancer patients experiencing pain, it offers several effective treatments:
Radiofrequency ablation (RFA): This uses heat, generated by radiofrequency energy to destroy cancerous tissues – often to treat painful bone metastases or tumours that are difficult to reach surgically
Cryoablation: Involves freezing cancerous tissues to destroy them. It is particularly useful for treating painful bone or soft tissue tumours, providing rapid pain relief
Nerve blocks: Involve the injection of anaesthetic agents or steroids near specific nerves to block pain signals. They can provide significant pain relief for patients with nerve-related pain
Palliative radiation therapy
In this instance, radiologists are involved with planning imaging only. The actual radiotherapy is performed by the radiation therapist, who works under the supervision of a radiation oncologist. Palliative radiation therapy is specifically designed to relieve symptoms and improve the quality of life for cancer patients. It focuses on pain control and symptom management rather than curing the disease.
Radiation oncologists deliver targeted doses of radiation to cancerous tissues, this palliative radiation therapy can help:
Reduce tumour size, alleviating pressure on surrounding tissues and nerves
Control bleeding or ulceration caused by tumours
Provide rapid pain relief, often within days to weeks of treatment
Improving quality of life
Dr Winter highlights that chronic pain can significantly diminish quality of life and contribute to depression, particularly in patients with underlying cancer. ‘These patients, in particular, should be considered for interventional procedures. For instance, there are highly effective treatments available to manage pain associated with pancreatic and pelvic cancers’.
‘Specialists, such as oncologists and neurologists, acknowledge the significant role of interventional radiology in pain management and collaborate closely with us to support their patients. As a rapidly advancing branch of radiology, it provides minimally invasive solutions and it is incredibly rewarding to witness patients regain their quality of life through effective symptom relief.’
Hospitalised cancer patients who engaged in a 10-minute virtual reality (VR) session experienced significantly lessened pain in a trial published in CANCER, a peer-reviewed journal of the American Cancer Society. Participants still experienced sustained benefits a day later.
Most cancer patients experience pain, and treatment usually involves medications including opioids. VR sessions that immerse the user in new environments have been shown to be a noninvasive and nonpharmacologic way to lessen pain in different patient populations, but data are lacking in individuals with cancer. To investigate, Hunter Groninger, MD, of Georgetown University School of Medicine and MedStar Health and his colleagues randomized 128 adults with cancer with moderate or severe pain to a 10-minute immersive VR intervention involving calm, pleasant environments or to a 10-minute two-dimensional guided imagery experience on an iPad tablet.
The investigators found that both interventions lessened pain, but VR sessions had a greater impact. Based on patient-reported scores from 0 to 10, patients in the guided imagery group reported an average decrease of 0.7 in pain scores, whereas those in the VR group reported an average drop of 1.4. Twenty four hours after the assigned intervention, participants in the VR group reported sustained improvement in pain severity (1.7 points lower than baseline before the VR intervention) compared with participants in the guided imagery group (only 0.3 points lower than baseline before the active control intervention).
Participants assigned to the VR intervention also reported improvements related to pain “bothersomeness” (how much the pain bothered them, regardless of the severity of the pain) and general distress, and they expressed satisfaction with the intervention.
“Results from this trial suggest that immersive VR may be a useful non-medication strategy to improve the cancer pain experience,” said Dr Groninger. “While this study was conducted among hospitalized patients, future studies should also evaluate VR pain therapies in outpatient settings and explore the impact of different VR content to improve different types of cancer-related pain in different patient populations. Perhaps one day, patients living with cancer pain will be prescribed a VR therapy to use at home to improve their pain experience, in addition to usual cancer pain management strategies like pain medications.”
