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.
