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Pathways to Discovery: Summer 2011

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UChicago Clinic Takes on Tough Pain for Cancer Patients

I consider a professional pain management consultation a cornerstone of patient care in oncology.
Suzanne Conzen, MD

Intractable, or uncontrolled, pain takes a devastating toll on the quality of life for the majority of patients in intermediate or advanced stages of cancer. Pain interferes with the activities of daily living and makes the cancer patient uncomfortable, irritable, depressed, and unable to sleep. It can be caused by growing tumors or by radiation, chemotherapy, or surgery that results in nerve damage or other painful side effects.

“We see many causes,” said Magdalena Anitescu, MD, PhD, assistant professor of anesthesia and critical care. “We try to tailor pain management toward each specific cause.”

Pain Services at UChicago
As many as 30 patients are treated daily in the Pain Clinic, which is located on the second floor of the Duchossois Center for Advanced Medicine. Other patients, many of them cancer patients, are seen in separate areas of the medical center. The clinic is equipped with five exam rooms and an additional exam room shared with the Perioperative Medicine Clinic. For interventional pain procedures, a dedicated room with a fluoroscopy C-arm allows the physicians to obtain real-time, moving X-ray images during the procedure.

“The patients we see are usually sent to us as a last resort because nobody can figure out what to do about the pain,” Dr. Anitescu said. “That’s our purpose. We attack the pain as aggressively as possible to try to make patients comfortable.”

Pain procedures are individualized to each patient’s pain pattern. An outpatient procedure that delivers small, intravenous doses of the anesthetic ketamine is being studied in the treatment of nerve pain caused by chemotherapy. Dr. Anitescu said the treatment is showing promise.

Another promising pain therapy is kyphoplasty for vertebral compression fractures caused by either osteoporosis or cancer, especially multiple myeloma, that has spread to vertebrae. This minimally invasive surgical procedure uses cement to provide instant pain relief for patients suffering from severe pain in their collapsed vertebrae.

“The simple fact is that no one gains anything from being in pain,” said Suzanne Conzen, MD, associate professor of medicine, who specializes in breast cancer diagnosis and treatment. “I consider a professional pain management consultation a cornerstone of patient care in oncology.”

Implantable Pain Pumps
Although several treatment options exist to help alleviate chronic pain, there is one that has not garnered much attention, according to Gita Rupani, MD, assistant professor of anesthesia and critical care, and one of the founders of the Pain Clinic.

Intrathecal drug delivery systems are battery-operated pumps that are implanted in a patient’s abdomen with a soft tube that carries medication to the area around the spinal cord known as the intrathecal space. Because the medication is being delivered directly to fluid surrounding the spine, only a small fraction of the medication is needed (1 mg intrathecal morphine versus 300 mg oral morphine). The decreased dose means fewer side effects, and the round-the-clock delivery provides more consistent pain relief.

Medication refills are needed every few weeks to 6 months, depending on the dosage.

“Most of the time, the pain pump patients are extremely happy with their quality of life because they are more awake and their pain is much better controlled,” Dr. Rupani said. “And they can spend quality time with their families.”

Comfort Team Eases Children’s Cancer Pain
When a child has cancer, one of his or her greatest fears is pain. At The University of Chicago’s Comer Children’s Hospital, a special palliative care service called the Pediatric Comfort Team makes every effort to ease patients’ pain during the treatment process. The team comprises a physician, nurse, pharmacist, child life specialist, chaplain, social worker, and psychiatrist, who all work together with the patient and his or her family to achieve pain management goals.

Pediatric Comfort Team Medical Director Melanie Brown, MD, said the team presents the patient with a “cocktail of services” that is very individualized. In addition to medication and narcotics, the patient may also respond favorably to complementary methods, such as hypnosis, sound therapy, massage, and aromatherapy.